SKELETAL PAIN IN CHILDREN: DON’T FORGET SCURVY! A PAEDIATRIC CASE SERIES

Appropriate nutritional intake is an important aspect in children’s overall health. In developed countries, malnutrition is related to chronic illness or restrictive dietary habits, related to psychiatric or behavioural conditions such as anorexia or neurodevelopmental disabilities. Recent studies consider vitamin C deficiency a re-emerging disease, although it is historically believed a disease of the past. We report 4 cases of scurvy in children which occurred in 2021 in our tertiary hospital in Catania. They were admitted for skeletal pain, refusal and/or inabilities to walk. Primary diagnostic considerations included infectious etiologies, malignant disease or orthopaedic problems. In anamnesis, only one out of four presented a diagnosis of neurodevelopmental disabilities. However, after scurvy was diagnosed, the remaining patients received an adequate neuropsychiatric evaluation reporting eating selective habits in children affected by behavioural disturbances. Recognition of the cutaneous findings, associated with skeletal pain, was vital in two cases for the diagnosis. Bone imaging findings (X-ray and MRI) were considered typical of scurvy after a good response to treatment with vitamin C.