Diagnostic Considerations
The differential diagnosis of scurvy includes vasculitis, thrombocytopenia, multiple myeloma, and folliculitis. [29] Suspect vitamin C deficiency when perifollicular hemorrhages with corkscrew hairs are present. [37]
When evaluating a patient with suspected scurvy, other conditions such as the following should also be considered:
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Acrodynia
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Autoimmune diseases (eg, Henoch-Schönlein purpura, systemic lupus erythematosus, Sjogren syndrome)
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Child abuse and neglect
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Clotting factor deficiencies
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Disseminated intravascular coagulation
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Hematologic malignancies (eg, acute lymphoblastic leukemia)
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Hypersensitivity vasculitis (leukocytoclastic vasculitis)
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Medication side effects
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Necrotizing gingivitis
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Platelet dysfunction (eg, immune thrombocytopenic purpura)
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Senile purpura
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Thrombophlebitis
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Vitamin D deficiency and related disorders
The bony pathology associated with scurvy could potentially be confused with physical abuse of a child. A good dietary history and the response to treatment with vitamin C establish the diagnosis and clear confusion. Nevertheless, in the developed world, vitamin C deficiency in children may be associated with neglect (ie, nutritionally inadequate diet) as a form of child abuse, even in the absence of overt signs of physical trauma.
Differential Diagnoses
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Anteroposterior radiograph of the lower extremities shows ground-glass osteopenia, a characteristic of scurvy.
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Perifollicular hemorrhage.
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Periodontal images of the patient taken before periodontal treatment. Extensive gingival overgrowth with severe periodontal inflammation was observed in the maxillary and mandibular arches at the first visit (July, 2008). Image from open access article Omori K, Hanayama Y, Naruishi K, Akiyama K, Maeda H, Otsuka F, Takashiba S. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report. Clin Case Rep. 2014 Dec; 2(6):286-95.
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Treatment protocol for above patient with extensive gingival overgrowth with severe periodontal inflammation in the maxillary and mandibular arches. Image from open access article Omori K, Hanayama Y, Naruishi K, Akiyama K, Maeda H, Otsuka F, Takashiba S. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report. Clin Case Rep. 2014 Dec; 2(6):286-95.
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Periodontal images taken before and after ascorbic acid supplementation. (A) Recurrent gingival overgrowth observed after the second gingivectomy and before ascorbic acid supplementation (September, 2011), (B) images taken after 9 months of ascorbic acid supplementation (June, 2012). The white arrows indicate typical sites of recurrent gingival overgrowth. Image from open access article Omori K, Hanayama Y, Naruishi K, Akiyama K, Maeda H, Otsuka F, Takashiba S. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report. Clin Case Rep. 2014 Dec; 2(6):286-95.
Tables
| Age | Recommended Amount |
|---|---|
| Birth to 6 mo | 40 mg |
| Infants 7-12 mo | 50 mg |
| Children 1-3 yr | 15 mg |
| Children 4-8 yr | 25 mg |
| Children 9-13 yr | 45 mg |
| Boys 14-18 yr | 75 mg |
| Girls 14-18 yr | 65 mg |
| Men | 90 mg |
| Women | 75 mg |
| Pregnant females <18 yr | 80 mg |
| Pregnant women 19-50 yr | 85 mg |
| Breastfeeding females <18 yr | 115 mg |
| Breastfeeding women 19-50 yr | 120 mg |
