A 7-year-old boy with scurvy owing to coeliac disease

Abstract

ABSTRACT A patient with scurvy presented with malnutrition and generalised myalgia, bone pain, petechial rash, ecchymosis, gingival hypertrophy and bleeding, and an inability to walk. Initially, the petechial rash, arthralgia and bone pain posed a diagnostic challenge, with differential diagnoses including IgA vasculitis (Henoch–Schönlein purpura, HSP) and leukaemia. However, the rash was not typical of HSP, and there were no pathological blood smear findings. Vitamin C levels in the plasma were prioritised before conducting further investigations, including bone marrow aspiration and skin biopsy. Laboratory and radiological findings confirmed undetectable vitamin C levels in the plasma, and other results were compatible with scurvy and malnutrition. Notably, the erythrocyte sedimentation rate was elevated. The cause of multivitamin deficiency and malnutrition was investigated, and coeliac disease was identified. Scurvy in patients with coeliac disease is very rarely reported. The aim of this article is to draw attention to the importance of assessing and managing the dietary habits of school-age children, and, if necessary, further investigation for coeliac disease, and to highlight that scurvy can mimic HSP. Abbreviations ESR: erythrocyte sedimentation rate; Hb: haemoglobin; HSP: Henoch–Schönlein purpura; WCC: white-cell count.