Scurvy as a differential diagnosis of chronic pain in the lower limbs in a patient with autism spectrum disorder (ASD): a narrative review of the literature

*Correspondence: [e-mail].

Abstract

Case Presentation: R.G., 9 years old, with Autism Spectrum Disorder (ASD), with significant food selectivity and without follow-up in a child neurology service. He started with pain in the lower limbs (LL) and altered gait pattern 3 months ago, with significant worsening of the condition 2 weeks ago. Due to the condition, the parents sought one Orthopedic, at which time immobilization was performed with boot in the LL. With the non-resolvability of the condition, they sought medical care again, this time at the Prontobaby Hospital da Criança for diagnostic investigation. On physical examination, it was possible to observe reduced strength in the lower limbs, pain and crying facies when the minor touched the limbs on the ground, as well as the presence of petechiae throughout the body and polyarticular edema of the LL. The Prontobaby team raised the hypothesis of hypovitaminosis C, due to the significant food selectivity and the findings of the physical examination. After dosing vitamin C, whose patient value was 0.05 mg/dl (reference value: 0.5 – 1.5 mg/dl), this vitamin was replaced. R.G. evolves, in 48 hours, with significant improvement of pain and gait pattern.

Discussion: Scurvy is a nutritional disease caused by severe deficiency of vitamin C, or ascorbic acid. Total body storage of vitamin C is 1,500 mg, and clinical features of deficiency occur after this level is reduced to less than 350 mg. Although vitamin C deficiency is common, scurvy is evidently rare, but it should be considered as a differential diagnosis in patients with significant food selectivity, such as several patients with ASD. In the early stages of scurvy, nonspecific symptoms appear. With evolution of the illness may arise anemia, muscle and bone pain, petechiae, edema of the LL and mood swings.The diagnosis is based on the clinical condition, dietary history of the patient and a physical examination based on suggestive findings. The improvement clinical after six weeks of ascorbic acid administration works as a therapeutic and diagnostic test, being considered the best evidence of scurvy.

Final Comments: In conclusion, scurvy, although rare, is a differential diagnosis of bleeding disorders, rheumatic diseases and diseases of legal medical interest. It is essential that the child neurologist be aware of the clinical condition to make the diagnosis, especially in patients with ASD with significant food selectivity, because it is a potentially fatal disease, but of easy and effective therapeutic intervention

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Artikel online veröffentlicht:
12. Mai 2025