SHM Converge Scientific Abstract ePoster Gallery-When a Child Can't Walk, Consider the Diet

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A 2-year-old boy with expressive language delay developed worsening refusal to bear weight over 1.5 weeks, progressing from refusing to walk to refusing to stand. He had decreased appetite for 2 weeks and parents reported possible leg pain not relieved by ibuprofen. No trauma, infection, or environmental exposures were identified. His diet was highly restrictive, consisting mainly of cereals, breads, and tortillas, with refusal of vegetables, fruits, and most meats.<br /><br />On exam, he was nonverbal but not in distress. Key findings included refusal to bear weight bilaterally, tenderness in the lower extremities, reddish-purple anterior maxillary gums, bilateral knee edema, and hyperpigmented non-blanching patches near the ankles from prior minor injuries. Neurologic exam was normal. Initial X-rays, brain/spine MRI, and abdominal/pelvic MRI were unrevealing.<br /><br />MRI of the lower extremities later showed bilateral symmetric metaphyseal marrow signal abnormality and adjacent edema, greatest at the knees, suggesting a nutritional/metabolic deficiency—specifically scurvy. Laboratory testing supported this diagnosis with a very low vitamin C level (0.1 mg/dL), mildly elevated ESR, and otherwise largely normal CBC, CRP, CK, and calcium/vitamin D levels.<br /><br />The child was treated with one dose of IV ascorbic acid, followed by oral vitamin C and a multivitamin, and was referred to a feeding program. His symptoms improved rapidly: within 3 days he had no pain and began crawling, and by 2 months he was running and playing normally.<br /><br />The case highlights that in nonverbal children or those with autism/language delay who present with inability to walk, a careful diet history is essential. Considering vitamin C deficiency early may help diagnose scurvy sooner and avoid extensive, costly testing.

Asset Subtitle

Maria Huang

Meta Tag

Author List Maria Huang

Category Clinical Vignettes

Concept Scurvy

Concept Ascorbic Acid

Concept Dietary History

Concept Vitamin C Supplementation

Concept Restrictive Diet

Distinguished Non-Finalist

Presenter Organization UC San Diego | Rady Children's Hospital-San Diego

Presenting Author Maria Huang

Track Pediatric

Keywords

scurvy

vitamin C deficiency

refusal to bear weight

pediatric limp

restrictive diet

metaphyseal marrow edema

gingival bleeding

nonverbal child

ascorbic acid treatment

nutritional deficiency

Scurvy

Ascorbic Acid

Dietary History

Vitamin C Supplementation

Restrictive Diet