{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T05:16:28Z","timestamp":1773119788710,"version":"3.50.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Rheumatology for All"},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100016979","name":"National Treasury","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016979","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential.<\/jats:p>\n                <jats:p>Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12969-024-00992-2","type":"journal-article","created":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T01:01:19Z","timestamp":1715994079000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Scurvy masquerading as IgA vasculitis"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4668-2575","authenticated-orcid":false,"given":"Hanna L.","family":"Kassa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Douglas-Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gill","family":"Schermbrucker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"De Lange","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Phoya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Butters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Hlela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashton","family":"Coetzee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebrahim","family":"Banderker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Webb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,18]]},"reference":[{"key":"992_CR1","doi-asserted-by":"crossref","unstructured":"Elouali A, El haddar Z, Bouabdella Y, Rkain M, Babakhouya A. A Case of Scurvy in a Child: An Uncommon but Important Diagnosis to Consider. Cureus. 2023 May 23 [cited 2023 Jun 14]; Available from: https:\/\/www.cureus.com\/articles\/156875-a-case-of-scurvy-in-a-child-an-uncommon-but-important-diagnosis-to-consider","DOI":"10.7759\/cureus.39369"},{"issue":"1","key":"992_CR2","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12969-015-0020-1","volume":"13","author":"JT Alqanatish","year":"2015","unstructured":"Alqanatish JT, Alqahtani F, Alsewairi WM, Al-kenaizan S. Childhood scurvy: an unusual cause of refusal to walk in a child. Pediatr Rheumatol. 2015;13(1):23.","journal-title":"Pediatr Rheumatol."},{"issue":"2","key":"992_CR3","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.ejim.2010.10.006","volume":"22","author":"E Magiorkinis","year":"2011","unstructured":"Magiorkinis E, Beloukas A, Diamantis A. Scurvy: Past, present and future. Eur J Intern Med. 2011;22(2):147\u201352.","journal-title":"Eur J Intern Med."},{"key":"992_CR4","doi-asserted-by":"crossref","unstructured":"Lynch KR, Santiago R. Symptomatic Vitamin C Deficiency in Two Developmentally Delayed Toddlers. Consultant. 2020 [cited 2023 Jun 14]; Available from: https:\/\/www.consultant360.com\/article\/consultant360\/symptomatic-vitamin-c-deficiency-two-developmentally-delayed-toddlers","DOI":"10.25270\/con.2020.05.00010"},{"issue":"3","key":"992_CR5","doi-asserted-by":"publisher","first-page":"684","DOI":"10.3390\/nu14030684","volume":"14","author":"S Trapani","year":"2022","unstructured":"Trapani S, Rubino C, Indolfi G, Lionetti P. A Narrative Review on Pediatric Scurvy: The Last Twenty Years. Nutrients. 2022;14(3):684.","journal-title":"Nutrients."},{"issue":"1","key":"992_CR6","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1186\/s43055-021-00553-7","volume":"52","author":"R S. D Dixit","year":"2021","unstructured":"S. D Dixit R, Khullar T, Rajeshwari K. Bilateral proptosis: an unusual primary presentation of scurvy\u2014a case report. Egypt J Radiol Nucl Med. 2021;52(1):175.","journal-title":"Egypt J Radiol Nucl Med"},{"key":"992_CR7","unstructured":"Hidayati A, Bintanjoyo L, Gunawan P, Noviandi R, Widia Y, Citrashanty I, et al. Clinical, laboratory, radiologic and ex juvantibus diagnosis of pediatric scurvy: A case report. J Pak Assoc Dermatol. 2022;32(3):650\u2013655."},{"key":"992_CR8","doi-asserted-by":"publisher","unstructured":"Brambilla A. Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past. Front Pediatr. 2018;6:126. https:\/\/doi.org\/10.3389\/fped.2018.00126.","DOI":"10.3389\/fped.2018.00126"},{"key":"992_CR9","doi-asserted-by":"publisher","first-page":"109963","DOI":"10.1016\/j.ijporl.2020.109963","volume":"133","author":"S Boone","year":"2020","unstructured":"Boone S, Stein F, Wilson PF, Musso MF. A child with obstructive oral cavity hemorrhagic bullae and refusal to walk. Int J Pediatr Otorhinolaryngol. 2020;133:109963.","journal-title":"Int J Pediatr Otorhinolaryngol."},{"issue":"3","key":"992_CR10","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1111\/scd.12459","volume":"40","author":"P Kothari","year":"2020","unstructured":"Kothari P, Tate A, Adewumi A, Kinlin LM, Ritwik P. The risk for scurvy in children with neurodevelopmental disorders. Spec Care Dentist. 2020;40(3):251\u20139.","journal-title":"Spec Care Dentist."},{"key":"992_CR11","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3389\/fped.2020.00008","volume":"8","author":"C Chalouhi","year":"2020","unstructured":"Chalouhi C, Nicolas N, Vegas N, Matczak S, El Jurdi H, Boddaert N, et al. Scurvy: A New Old Cause of Skeletal Pain in Young Children. 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Br J Dermatol. 2021;185(S1):19\u201320.","DOI":"10.1111\/bjd.19956"},{"issue":"1","key":"992_CR15","first-page":"56","volume":"17","author":"MA Gonzalez-Gay","year":"2005","unstructured":"Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Scocco GL, Pujol RM. Review Cutaneous vasculitis: A diagnostic approach. Clin Exp Rheumatol. 2005;17(1):56\u201361.","journal-title":"Clin Exp Rheumatol."},{"issue":"2","key":"992_CR16","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1097\/01.bor.0000145519.68725.5a","volume":"4","author":"MA Gonzalez-Gay","year":"2005","unstructured":"Gonzalez-Gay MA, Garcia-Porrua C, Pujol RM. Clinical approach to cutaneous vasculitis. Curr Opin Intern Med. 2005;4(2):146\u201351.","journal-title":"Curr Opin Intern Med"},{"issue":"6","key":"992_CR17","doi-asserted-by":"publisher","first-page":"e249113","DOI":"10.1136\/bcr-2022-249113","volume":"15","author":"R Chaluvaraj","year":"2022","unstructured":"Chaluvaraj R, Ashley PF, Parekh S. Scurvy presenting primarily as gingival manifestation in a young child: a diagnostic dilemma. BMJ Case Rep. 2022;15(6):e249113.","journal-title":"BMJ Case Rep."},{"key":"992_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2010\/717518","volume":"2010","author":"L Ghedira Besbes","year":"2010","unstructured":"Ghedira Besbes L, Haddad S, Ben Meriem C, Golli M, Najjar Fadhel M, Guediche MN. Infantile Scurvy: Two Case Reports. Int J Pediatr. 2010;2010:1\u20134.","journal-title":"Int J Pediatr"},{"issue":"3","key":"992_CR19","doi-asserted-by":"publisher","first-page":"e20182824","DOI":"10.1542\/peds.2018-2824","volume":"144","author":"A Nastro","year":"2019","unstructured":"Nastro A, Rosenwasser N, Daniels SP, Magnani J, Endo Y, Hampton E, et al. Scurvy Due to Selective Diet in a Seemingly Healthy 4-Year-Old Boy. 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J Trop Pediatr. 2022;68(3):fmac029.","journal-title":"J Trop Pediatr"},{"issue":"18","key":"992_CR24","doi-asserted-by":"publisher","first-page":"8323","DOI":"10.3390\/app11188323","volume":"11","author":"MF Gicchino","year":"2021","unstructured":"Gicchino MF, Romano A, Cioffi S, Fiori F, del Miraglia Giudice E, Lucchese A, et al. Oral Manifestations in Scurvy Pediatric Patients: A Systematic Review and a Case Report. Appl Sci. 2021;11(18):8323.","journal-title":"Appl Sci"},{"key":"992_CR25","unstructured":"N\u00fa\u00f1ez MRT. Scurvy: Cases of an Old Disease in Two NeurotypicalPediatric Patients in a Children\u2019s Hospital.\u00a0Am J Med Case Rep. 2022;3(1):1051."},{"key":"992_CR26","unstructured":"Centers for disease control and prevention. 2 to 20 years: Boys Stature-for-age and Weight-for-age percentiles. 2023. Available from: http:\/\/www.cdc.gov\/growthcharts\/data\/set1clinical\/cj41c021.PDF"}],"container-title":["Pediatric Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-024-00992-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12969-024-00992-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-024-00992-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T01:02:09Z","timestamp":1715994129000},"score":1,"resource":{"primary":{"URL":"https:\/\/ped-rheum.biomedcentral.com\/articles\/10.1186\/s12969-024-00992-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,18]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["992"],"URL":"https:\/\/doi.org\/10.1186\/s12969-024-00992-2","relation":{},"ISSN":["1546-0096"],"issn-type":[{"value":"1546-0096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,18]]},"assertion":[{"value":"22 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Human Research Ethics Committee of the Faculty of Health Sciences at the University of Cape Town has carefully examined and approved the case report with a REF number of 848\/2023. The Declaration of Helsinki's tenets and relevant national and international criteria for conducting case reports involving children with mental impairments were followed in terms of ethical considerations and methodology.The child's parents or legal guardians have been fully informed about the nature, goal, and possible risks and advantages of their child's participation in this case report. The legal representatives have given their written informed consent, and their identities will be kept private during the publication process.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The legal representatives granted their written approval, which includes express permission to share pertinent medical data for publication purposes. A thorough description of the case report's nature and goals, possible risks and advantages, and guarantees about the anonymity and privacy of the child were all part of the permission procedure. Before voluntarily deciding to take part in the publication process, the legal representatives were given the chance to clarify matters and raise questions.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"56"}}