Disclosures: Jennifer Horng, MD: No financial relationships or conflicts of interest

Case Description: 5 year old boy with autism presented with refusal to bear weight. He had persistent resistance to flexion and external rotation of bilateral hips and did not bend or straighten his legs. Pelvic x-ray showed demineralization of bilateral femurs and MRI showed diffuse marrow abnormality in bilateral proximal and distal tibial and femoral metaphyses. Imaging and history of restricted diet were consistent with vitamin C deficiency.

Setting: Academic Acute Inpatient Pediatric Rehabilitation Unit

Patient: 5 year old boy with autism, nonverbal communication and restricted diet presented with progressive, subacute refusal to bear weight. Assessment/

Results: On admission to acute rehab, the patient initially refused to ambulate and bear weight on his right knee. He was only able to extend his knees and begin weight-bearing on his feet while seated in a chair. Therapy focused on ambulation, communication, and pre-feeding skills (as the patient had PO aversion). Patient received supplements, including vitamin C, and his mother was educated on how to fortify his food. By the end of acute rehab, the patient was able to ambulate short distances with hand held assist and small steps with rail and hand held assist. He also used a communication device to communicate requests.

Discussion: Children with autism may behaviorally have a severely restricted diet and are at risk for nutrient deficiencies, including vitamin C. Since vitamin C is essential to synthesize collagen, vitamin C deficiency can result in musculoskeletal complaints. Treatment includes vitamin C supplementation and care from the entire interdisciplinary team including nutritionist, psychologist, physical, occupational and speech therapists.

Conclusion: Physiatrists should consider scurvy in patients with restricted diet. Scurvy can present as musculoskeletal complaints and is reversible with vitamin C supplementation and treated with interdisciplinary care.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2020

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/goldfish-cracker-diet-and-a-progressive-refusal-to-bear-weight/