Objective:

We present an atypical presentation of scurvy with lower extremity pain and gait disturbances as the primary symptom in a pediatric patient.

Background:

Scurvy, a consequence of vitamin C deficiency, often manifests with systemic signs. However, neuro-musculoskeletal presentations, especially in pediatric patients with dietary restrictions, can pose diagnostic challenges for neurologists.

Design/Methods:

N/A

Results:

A 7-year-old female with a past medical history of feeding disorder of early childhood, food aversion with restrictive diet and developmental dysplasia of the hip presented with bilateral lower leg pain, abnormal gait, and a petechial rash of four days duration. Clinically, she demonstrated a waddling gait, further compounded by a positive Gower sign and bilateral lower extremity weakness. No other neurological deficits were elicited. X-rays showed an osteochondroma originating from the distal left femur. MRI of the brain indicated an incidental pineal cyst, while other regions, including the thoracolumbar spine, remained unremarkable. She was started on Vitamin C supplementation while awaiting Vitamin C levels, which later returned significantly low. She was diagnosed with scurvy and discharged with acetaminophen and ibuprofen for pain control and instructed to continue Vitamin C supplementation. At follow-up, her symptoms had resolved, and her gait was normal. She continues to follow gastroenterology and a nutritionist to address her food aversion and nutritional deficiencies.

Conclusions:

Scurvy is a vitamin C deficiency characterized by nonspecific symptoms, including fever, fatigue, irritability, and musculoskeletal symptoms, such as pain in the lower limbs. However, as this case elucidates, it can masquerade as a neuromuscular disorder. Neurologists should consider nutritional deficiencies in the differential diagnoses of gait abnormality, especially in pediatric populations with dietary limitations presenting with neuromuscular complaints.