Disclosures: Ami Hampole, DO: No financial relationships or conflicts of interest

Case Diagnosis: New gait difficulties in a pre-teen child with limited diet lead to a diagnosis of scurvy.

Case Description: A 12-year-old nonverbal, independently ambulating female with seizure disorder, global developmental delay and autism spectrum disorder presented to an outpatient pediatric physiatry clinic for new-onset gait abnormalities. As of January 2021, patient’s gums started to swell and bleed. Neurologic, dental and hematologic-oncologic initial evaluations were nondiagnostic. Extensive hematologic testing was unremarkable. In February, mother noticed extensive bruising in the extremities and progressive gait difficulties. All other review of systems were negative aside from excessive laughing, infrequent orthostatic symptoms, constipation, bowel incontinence, and a limited diet. On physical exam, patient showed swollen and friable gums, extensive bruising in extremities, some guarding and swelling of left knee, high bilateral knee-flexion tone and trace plantar-flexion tone, normal arches, and crouched, toe-walking gait.

Setting: Outpatient pediatric physiatry clinicAssessment/

Results: Vitamin C level was found to be < 0.01 milligrams/deciliters. Patient was diagnosed with scurvy. Additionally, imaging showed partial tear of left biceps femoris with associated stress injury around the distal femoral metaphysis. In this particular case, scurvy, spasticity and the left knee injury, all likely contributed to this child's gait abnormality.

Discussion: It is important to consider vitamin deficiencies when evaluating children with limited dietary intake. This patient had an extensive work-up over a 2 month period prior to the diagnosis of scurvy. In the literature, there are few cases of scurvy seen in autistic and cerebral palsy children due to their high likelihood of poor oral intake, and there are hardly any cases of gait abnormalities from scurvy in physiatry literature.

Conclusion: Vitamin deficiencies can contribute to gait abnormalities or other unexplained symptoms. Pediatric physiatrists frequently follow children with limited or restrictive oral feeding and in this case played an important role in diagnosing scurvy while evaluating new gait abnormalities.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/new-difficulty-ambulating-in-a-pre-teen-child-a-complicated-case-report-of-scurvy/