Ecchymosis and Bilateral Leg Pain in an 11-Year-Old Girl With Developmental Delay

Jeffrey M. Kalczynski, DO; Bryan T. Luu, DO


May 24, 2023

The primary treatment of scurvy or vitamin C deficiency is vitamin C replacement.[1] Possible treatment protocols have not been standardized; however, most regimens consist of a short daily course of high-dose vitamin C, after which the regimen transitions to a lower dose for an extended period. One regimen recommends giving 2 g of vitamin C for 3 days; the dosage is then decreased to 500 mg/d for 1 week. After 1 week, the dose is further decreased to 100 mg/d for 3 months.[5] Most adults are treated with 300-1000 mg/d for up to 1 month.[1] The most important end point in treating scurvy is to provide vitamin C until clinical symptoms resolve. Even at the late stages of scurvy, replacement of vitamin C can bring about full recovery.[1]

In patients with developmental delay, it is important to consider nutritional deficiencies because this population tends to have very restricted diets. Other at-risk populations include persons who are experiencing food instability, unhoused persons, and those with substance use disorders. Scurvy has also been reported in older patients who consume a "tea and toast" type of diet.[1] Although scurvy is typically taught in medical school as an extinct disease that affected mariners during the Age of Exploration, this case demonstrates the importance of maintaining clinical suspicion for it, especially in patients with strong risk factors.


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