{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T13:12:21Z","timestamp":1780405941242,"version":"3.54.1"},"reference-count":25,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,1]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>Scurvy, a disease caused by ascorbic acid (vitamin C) deficiency, is a rare disease in the modern world. We report a case of a boy in middle childhood, with a background of autism, presenting bed-bound due to progressive bilateral lower limb pain, with concomitant rashes, bleeding gums and worsening lethargy. Detailed dietary history revealed a severely restricted diet. Physical examination showed bilateral lower limb ecchymoses, perifollicular hemorrhages, perifollicular hyperkeratosis and cockscrew hairs which are pathognomonic features of scurvy. A low serum ascorbic acid level confirmed the diagnosis. Therapy with oral vitamin C supplement and rehabilitation with multidisciplinary care was successful, with complete resolution of symptoms. This case emphasises the importance of thorough dietary evaluation in children with autism and food selectivity presenting with non-specific symptoms. Physician awareness of nutritional deficiencies avoids unnecessary extensive investigations and sub-specialty referrals and translates to savings in medical expenses.<\/jats:p>","DOI":"10.1136\/bcr-2023-258819","type":"journal-article","created":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T10:35:35Z","timestamp":1703932535000},"page":"e258819","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Scurvy presenting as difficulty in walking in a child"],"prefix":"10.1136","volume":"16","author":[{"given":"Heidi Nerissa Zhixuan","family":"Yu","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5005-3499","authenticated-orcid":false,"given":"Shi Yun","family":"Chia","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, KK Women's and Children's Hospital, Singapore"},{"name":"Department of Dermatology, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,30]]},"reference":[{"key":"2025082708561601000_16.12.e258819.1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1002\/ncp.10914","article-title":"History of scurvy and use of vitamin C in critical illness: a narrative review","volume":"38","author":"Dresen","year":"2023","journal-title":"Nutr Clin Pract"},{"key":"2025082708561601000_16.12.e258819.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2009.00205.x"},{"key":"2025082708561601000_16.12.e258819.3","doi-asserted-by":"publisher","DOI":"10.1093\/emph\/eoz024"},{"key":"2025082708561601000_16.12.e258819.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198604033141407"},{"key":"2025082708561601000_16.12.e258819.5","first-page":"115","article-title":"Ascorbic acid deficiency: a case report","volume":"78","author":"Solanki","year":"2011","journal-title":"J Dent Child (Chic)"},{"key":"2025082708561601000_16.12.e258819.6","doi-asserted-by":"publisher","DOI":"10.1177\/1203475416660311"},{"key":"2025082708561601000_16.12.e258819.7","doi-asserted-by":"crossref","DOI":"10.3390\/nu14030684","article-title":"A narrative review on pediatric scurvy: the last twenty years","volume":"14","author":"Trapani","year":"2022","journal-title":"Nutrients"},{"key":"2025082708561601000_16.12.e258819.8","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1097\/BPO.0000000000001731","article-title":"Modern day scurvy in pediatric orthopaedics: a forgotten illness","volume":"41","author":"Pan","year":"2021","journal-title":"Journal of Pediatric Orthopaedics"},{"key":"2025082708561601000_16.12.e258819.9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jcot.2014.12.003","article-title":"Scurvy in pediatric age group \u2013 a disease often forgotten","volume":"6","author":"Agarwal","year":"2015","journal-title":"Journal of Clinical Orthopaedics and Trauma"},{"key":"2025082708561601000_16.12.e258819.10","unstructured":"Shah D , Sachdev H , Kliegman R , et al . 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