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CASE REPORT: scurvy in a child with autistic spectrum disorder due to food selectivity

Apresentação do caso

Case presentation: S.O.R, male, 2 years and 6 months, language and social delay. The diet was based on bread, rice, beans and yogurt. Petechiae and gingival bleeding were noted 55 days ago. After 15 days, progressive pain in the lower limbs prevented the child to sit or walk. The clinical examination showed edema, pseudofolliculitis, petechiae and intense pain on palpation and mobilization of the lower limbs, bleeding spots and hypertrophy in the gingivae. Blood count and cerebral spinal fluid analysis were performed, with results within the normal range. Bone marrow biopsy ruled out acute leukosis. A limb MRI presented marked bone marrow edema of the metaphyseal region of both femurs, tibias and fibulas, with signs of periostitis and edema of the adjacent muscle groups. The child was given analgesics and ascorbic acid supplementation (300mg/day orally), showing in 2 days progressive improved lower limb pain and partial motor recovery. The M-Chat scale was applied and positive for Autism Spectrum Disorder.

Discussão

Discussion: Around 46% to 89% of patients with Autism Spectrum Disorder show food selectivity, depending on shape, color and texture. The selective and repetitive intake of foods, especially those with high-calorie content, can contribute to obesity and nutritional deficit, resulting in significant morbidity. Scurvy diagnosis is rare in the literature, and there are few published studies on the frequency of nutritional deficiencies in the pediatric population with Autism Spectrum Disorder. However, in the United States, vitamin C deficiency represents less than 2% of the nutritional deficits in children aged 6 to 11 years and less than 4% in adolescents. Bone and soft tissue manifestations secondary to scurvy can mimic other osteoarticular disorders, including osteomyelitis.

Comentários finais

In this case, clinical signs suggestive of scurvy and behavioral inflexibility led to the diagnosis of Autism Spectrum Disorder, in addition to vitamin D and iron deficiency. The complete analysis of clinical history provided shortcuts to the correct diagnosis. In the context of a restricted diet and osteoarticular manifestation, the possibility of micro and macronutrient deficiencies, including vitamin C, must be raised. Proper recognition of the condition avoids unnecessary investigations and treatments

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