Although rare in high-income countries, scurvy remains an important consideration in children with longstanding and highly restrictive eating habits, particularly those with autism spectrum disorder (ASD). Children with scurvy often undergo evaluation for infection, inflammatory bone disease, or malignancy before the diagnosis becomes apparent. This report describes an eight-year-old non-verbal boy with ASD who presented with progressive lower extremity pain and refusal to bear weight or walk. Imaging demonstrated diffuse osteopenia with classic metaphyseal changes of scurvy on radiographs, multiple vertebral compression deformities, and multifocal marrow signal abnormalities on MRI that closely mimicked chronic recurrent multifocal osteomyelitis (CRMO). Further assessment revealed a markedly restricted diet, characteristic skin findings, and a serum vitamin C level < 0.1 mg/dL, confirming the diagnosis of scurvy. Additional nutritional deficiencies of vitamins A, D, and E were identified. Following initiation of nutritional rehabilitation including vitamin C therapy, the patient experienced rapid improvement, with resolution of pain and restoration of weight-bearing ability. This case illustrates that pediatric scurvy can closely mimic CRMO clinically and radiographically, highlighting an important diagnostic pitfall and emphasizing the importance of careful dietary assessment to avoid unnecessary invasive diagnostic procedures.

Vitamin C is crucial for normal physiology and function. Severely insufficient levels of vitamin C can disrupt these processes, resulting in scurvy, a condition characterized by compromised collagen production and tissue degradation. The purpose of this report is to present a complex case of a pediatric patient with autism spectrum disorder exhibiting nonspecific oral lesions. Histopathological examination of the lesions revealed granulomatous inflammation, suggesting an initial diagnosis of orofacial granulomatosis, with a recommendation to rule out Crohn's disease. Further investigation confirmed the presence of vitamin C deficiency, with the oral lesions responding positively to vitamin C supplementation, indicating that the oral lesions were a manifestation of scurvy. In the United States, scurvy is rare and usually associated with underlying conditions and restrictive diets; if left untreated, severe complications affecting patients' life expectancy may occur. Understanding the clinical manifestations of vitamin C deficiency is crucial for timely diagnosis and effective management.

Scurvy is an increasingly recognized but frequently overlooked nutritional deficiency in developed countries. We report a 55-year-old man with obesity and type 2 diabetes mellitus who presented with progressive petechiae and ecchymoses concerning for cutaneous vasculitis. Extensive hematologic, rheumatologic, infectious, and dermatologic evaluations, including skin biopsy, were unrevealing. Symptoms were initially attributed to aspirin use without improvement following dose reduction. Subsequent nutritional assessment revealed an undetectable plasma vitamin C level (<0.1 mg/dL) in the setting of chronically poor dietary quality with minimal fruit and vegetable intake. The patient was treated with vitamin C supplementation and nutrition counseling, with subsequent clinical improvement and normalization of vitamin C levels. This case highlights how micronutrient deficiencies may occur despite adequate food access and emphasizes the importance of dietary assessment in patients with unexplained bleeding manifestations to avoid diagnostic delay and unnecessary testing.

Copper, iron, zinc, calcium, and vitamins A, C, and D are essential nutrients but can cause disease when deficient or excessive in exotic animals. Copper toxicity often results from dietary overload, causing liver damage and hemolysis, while deficiency leads to neurologic signs. Iron overload, especially in birds, causes hemosiderosis and organ damage. Zinc toxicity commonly arises from ingesting metal objects, producing neurological and gastrointestinal signs. Vitamin imbalances cause diverse effects: vitamin A affects epithelial health, vitamin C deficiency causes scurvy, and vitamin D toxicity leads to hypercalcemia and tissue calcification. Proper diet management is critical.

A variety of skin conditions may be important diagnostic indicators for disorders of the digestive tract and liver. In inflammatory bowel diseases, the most common cutaneous manifestations are erythema nodosum and pyoderma gangrenosum. Autoimmune liver diseases are often associated with cutaneous manifestations such as hidradenitis suppurativa, vitiligo, psoriasis and alopecia areata. Lichen planus or porphyria cutanea tarda can also be induced by infectious hepatitis. Enteral malabsorption can lead to deficiencies and characteristic skin changes, such as celiac disease, acrodermatitis enteropathica, pellagra and scurvy. In addition, cutaneous sequelae, including various exanthems and adverse reactions, from drug treatment of intestinal and liver diseases are possible. Likewise, so-called paradoxical reactions in which new and previously absent skin conditions (e.g. psoriasis) may also develop, especially following treatment with biological products. Thus, gastroenterologists should recognize and diagnose cutaneous changes that are new or evolving in patients with intestinal and liver diseases in order to initiate appropriate therapy.

Scurvy, caused by severe vitamin C deficiency, is increasingly being reported in modern developed countries, particularly among children with restrictive diets. The non-specific presentation often leads to extensive investigations and diagnostic delays. We report the case of a 5.5-year-old boy born to consanguineous parents, with a history of language delay and severe selective eating, who presented with a two-week history of progressive limping and hemorrhagic gingival hypertrophy. Initial workup raised suspicion for hematologic malignancy, prompting extensive investigations, including bone marrow aspiration and maxillary biopsy, all of which were negative. A detailed dietary history revealed an extremely restricted diet consisting solely of pasteurized milk and biscuits for over three years. The vitamin C level was severely low at 3 µmol/L (normal range: 26-84 µmol/L), confirming the diagnosis of scurvy. Treatment with intravenous vitamin C (250 mg daily for one week) followed by oral supplementation resulted in dramatic improvement, with the patient regaining ambulation within 48 hours. Complete clinical and biochemical resolution occurred within three months. This case highlights the critical importance of obtaining a detailed dietary history in children presenting with unexplained musculoskeletal symptoms, hemorrhagic manifestations, or failure to thrive. Scurvy remains a relevant diagnosis in modern pediatric practice, particularly among children with neurodevelopmental conditions and food selectivity. Early recognition can prevent unnecessary invasive procedures and expensive diagnostic workups.

Background: Scurvy, a condition caused by vitamin C deficiency, has traditionally been considered eradicated in high-income countries (HICs; World Bank classification). However, emerging evidence suggests its re-emergence within identifiable vulnerability clusters, challenging the conventional assumptions about nutritional adequacy in affluent settings. This study aimed to systematically characterize the contemporary clinical and epidemiological profile of scurvy in HICs and quantify its multisystem burden. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251013454). PubMed, Embase, Web of Science, and Scopus were searched (2012-2025). Case reports, case series, and observational studies reporting clinically or biochemically confirmed scurvy in HICs were included in this review. A multilevel random-effects meta-analysis was performed using restricted maximum likelihood estimation, incorporating robust variance estimation to account for within-study dependence and hierarchical data structures. Multisystem involvement was modeled as a count outcome, and system-specific prevalence was estimated using logit-transformed proportions. Results: Twenty-five studies, including 147 patients, were analyzed. Patients diagnosed with scurvy frequently presented with involvement of multiple organ systems, with a pooled mean of 2.29 affected organ systems per patient (95% CI: 1.62-2.96; I[2] = 66.8%), highlighting clinically relevant heterogeneity in presentation. Musculoskeletal involvement was the most frequent clinical domain (OR 1.82; 95% CI: 0.98-3.38), whereas neurological manifestations were significantly less common (OR 0.42; 95% CI: 0.28-0.62; p < 0.001). Age was the only significant moderator, showing a modest inverse association with musculoskeletal involvement (OR 0.97; p = 0.035). Across studies, cases predominantly clustered in pediatric patients with neurodevelopmental disorders, restrictive dietary patterns, medically complex conditions, and psychosocial vulnerability. Conclusions: Scurvy persists in high-income countries as a clinically under-recognized condition occurring predominantly in vulnerable populations with restrictive dietary patterns, neurodevelopmental disorders, and psychosocial vulnerability. The available evidence suggests that contemporary scurvy is frequently associated with multisystem manifestations; however, the contribution of concomitant micronutrient deficiencies cannot be excluded. These findings highlight the need for comprehensive nutritional assessment and targeted nutritional screening in high-risk populations to prevent diagnostic delays and avoidable morbidity.

Scurvy (vitamin C deficiency) can present with a wide range of musculoskeletal manifestations that mimic rheumatologic disease. A 53-year-old man was admitted with progressive muscle weakness and dizziness and was noted to have a non-blanching rash and joint swelling. Initial evaluation raised concern for inflammatory arthritis, inflammatory myopathy, or vasculitis. Although the C-reactive protein level was elevated, an extensive rheumatologic serologic workup was unrevealing. Arthrocentesis of the knee demonstrated hemarthrosis. Further dietary history revealed severe nutritional deficiency, with intake consisting predominantly of fast food, and the serum vitamin C level was undetectable. Treatment with vitamin C supplementation led to marked clinical improvement.