HOME: THE JOHN LAVERTY, JR. CASE: FALSE SBS CHARGES * WRONGFUL CONVICTION & IMPRISONMENT

THE "SHAKEN BABY SYNDROME" MYTH: Why top scientists say it isn't possible to shake an infant hard enough to cause the symptoms used to diagnose SBS and the probable real causes

Infantile Scurvy Articles (Barlow's disease)

"During one trial, the prosecution stated that infantile scurvy was no longer
seen. I replied with ‘Yes it is. But it is not called ‘scurvy', it is called the
shaken baby syndrome." --Dr. Archie Kalokerinos, MD

Metabolic rib injuries
SBS flaws: Dr. Buttram 
Caffey ("invented" SBS) revisted  
SBS History: Scurvy suspected as cases of subdural hematomas 
Eyelids
Bone Callus
Inter cranial Hemorrhaging
Online Modern E Medicine Site
Clemetson: Vit C
Swollen or Fat Cheeks
Scurvy in Monkeys
Eyes: Scurvy Ocular Lesions
Scurvy Online
Scurvy: SIDS
Scurvy Signs and Symptoms
Scurvy: Shaken Baby by Kalokerinos
Shaken Baby or Barlows
Scurvy: Vaccine Injury
Infantile Scurvy: World Literature
Dr. Kalokerinos: Shaken Baby (scurvy)
Shaken Baby or Barlows?
Baby Alan Case  Autopsy  Testimony
Caffey Original SBS Hypothesis
Caffey Revisted: False Diagnosis
Vitamin C Expert: Dr. Clemetson
Antibiotics: Vit C Deficiency
Endotoxemia
Scurvy: Hemorrhages of the EYE
John's Case: Prenatal Vitamin C Deficiency
SBS Misdiagnosis of the Yurko Case
Questioning the SBS "Evidence" Base
SBS: Child Abuse or Something Else?
Emergency Pediatric Medicine: Differential Diagnosis

Scherzer E. Arch Fr Pediatr. 1982 Aug-Sep;39(7):453-4.Links
[Iconographic rubric: infantile scurvy]
[Article in French]

Bachy A, Hendrickx E, Vandercam J, Gérard P, Dochain J.

Pediatr Radiol. 1976 Aug 20;4(4):251-3.Links
Neonatal scurvy: report of a case.
Hirsch M, Mogle P, Barkli Y.

An Esp Pediatr. 1991 Mar;34(3):243-6.Links
[Radiologic diagnosis of Möller-Barlow disease (scurvy). Apropos of a case]
[Article in Spanish]

Burches Greus E, Lecuona López C, Ardit Lucas J, Aguilar Bacallado F, García Vicent C, Tomás Ratés C, Alvarez Angel V, Donderis Folgado P.

Servicio de Pediatría, Hospital General Universitario de Valencia.

Ryoikibetsu Shokogun Shirizu. 1998;(21 Pt 2):405-7.Links
[Scurvy, Möller-Barlow disease]
[Article in Japanese]

Mase K.
Department of Internal Medicine, Sanyo Hospital.

East Mediterr Health J. 2001 Nov;7(6):1070-2.Links
Perifollicular purpura must not be forgotten in scurvy: case reports.
Shamsaddini S, Shakibi MR, Atapoor J.

Kerman University of Medical Sciences Kerman Darman Hospital, Kerman, Islamic Republic of Iran.

Ann Dermatol Venereol. 2000 May;127(5):510-2.
[Scurvy presenting with ecchymotic purpura and hemorrhagic ulcers of the lower limbs]
[Article in French]

Boulinguez S, Bouyssou-Gauthier M, De Vençay P, Bedane C, Bonnetblanc J.

Service de Dermatologie, CHU Dupuytren, 87042 Limoges Cedex.

INTRODUCTION: The risk of vitamin C deficiency is underestimated in industrialized countries and is only disclosed in rare cases of severe scurvy. CASE REPORT: We report three cases of scurvy presenting with ecchymotic purpura and hemorrhagic ulcerations of the lower limbs. Vitamin C supplementation led to rapid improvement of the skin lesions. DISCUSSION: Clinical diagnosis of low-grade deficiency can be difficult. Biological diagnosis requires special care in sample taking and transport.

Turk J Pediatr. 1998 Apr-Jun;40(2):249-53.Links
Scurvy. A case report.
Yilmaz S, Karademir S, Ertan U, Kuyucu S, Hallioglu O, Ocal B, Mavis N.

Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkey.

An 18-month-old girl presented with irritability, epistaxis, spongy appearance of the gums perifollicular papules with follicular hyperkeratosis, ecchymosis, painful swollen knees and scorbutic rosary. Her diet consisted mainly of wheat flour. X-ray of the knees showed findings compatible with scurvy. Ascorbic acid level was below 0.003 g/L. Ascorbic acid therapy resulted in a dramatic clinical improvement. Scurvy is an uncommon disease in our society today. It is important to recognize the signs and symptoms of scurvy because it is easily treated with vitamin C replacement.

Int J Dermatol. 2007 Feb;46(2):194-8.
Scurvy in a 10-month-old boy.
Larralde M, Santos Muñoz A, Boggio P, Di Gruccio V, Weis I, Schygiel A.
Pediatric Dermatology Division and Pediatric Department, Ramos Mejía Hospital, Buenos Aires, Argentina. margaritalarraide@fibertel.com.ar

We report a 10-month-old boy with inflammatory and necrotic gingival lesions, fever, irritability, and pseudoparalysis of the legs. Laboratory examinations revealed moderate anemia and skeletal X-rays showed osteopenia, scorbutic rosary at the costochondral junctions, and "corner sign" on the proximal metaphyses of the femora. The boy had been fed only with diluted cow's milk. He had never taken solid food, vitamin C, or iron complement. Seventy-two hours after starting oral vitamin C supplementation, there was significant improvement in the patient's gingival lesions and general health. The clinical presentation and laboratory and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy. Scurvy, a dietary disease due to the deficient intake of vitamin C, is uncommon in the pediatric population. In an infant who has never received vitamin C, the combination of gingival lesions, pseudoparalysis, and irritability strongly suggests a diagnosis of scurvy. The clinical picture, together with the laboratory data, radiological studies, and therapeutic response to vitamin C administration, confirmed the diagnosis.

Pediatrics. 2001 Apr;107(4):E46.

Comment in:
Pediatrics. 2001 Apr;107(4):E45.

Am J Clin Dermatol. 2007;8(2):103-6.Links
Infantile scurvy: an old diagnosis revisited with a modern dietary twist.
Burk CJ, Molodow R.

Pediatric Dermatology, University of Miami, Miami, Florida 33125, USA. cynthiajburk@yahoo.com

Ascorbic acid (vitamin C) is necessary for the formation of collagen, reducing free radicals, and aiding in iron absorption. Scurvy, a disease of dietary ascorbic acid deficiency, is uncommon today. Indeed, implementation of dietary recommendations largely eradicated infantile scurvy in the US in the early 1900s. We present a case of an otherwise healthy 2-year-old Caucasian girl who presented with refusal to walk secondary to pain in her lower extremities, generalized irritability, sleep disturbance, and malaise. The girl's parents described feeding the patient an organic diet recommended by the Church of Scientology that included a boiled mixture of organic whole milk, barley, and corn syrup devoid of fruits and vegetables. Physical examination revealed pale, bloated skin with edematous, violaceous gums and loosening of a few of her teeth. Dermatologic findings included xerosis, multiple scattered ecchymoses of the extremities, and perifollicular hemorrhage. Laboratory and radiographic evaluation confirmed the diagnosis of scurvy. The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid and significant dietary modification. In this case report, we revisit the old diagnosis of scurvy with a modern dietary twist secondary to religious practices. This case highlights the importance of taking a detailed dietary history when evaluating diseases involving the skin.

Rev Clin Esp. 1996 Aug;196(8):570.Links
[Vitamin C deficiency and hemorrhagic syndrome]
[Article in Spanish]

Rodríguez Cuartero A.

Pediatrics. 2001 Sep;108(3):E55.
An orange a day keeps the doctor away: scurvy in the year 2000.
Weinstein M, Babyn P, Zlotkin S.

Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada. michael.weinstein@sickkids.on.ca

Scurvy has been known since ancient times, but the discovery of the link between the dietary deficiency of ascorbic acid and scurvy has dramatically reduced its incidence over the past half-century. Sporadic reports of scurvy still occur, primarily in elderly, isolated individuals with alcoholism. The incidence of scurvy in the pediatric population is very uncommon, and it is usually seen in children with severely restricted diets attributable to psychiatric or developmental problems. The condition is characterized by perifollicular petechiae and bruising, gingival inflammation and bleeding, and, in children, bone disease. We describe a case of scurvy in a 9-year-old developmentally delayed girl who had a diet markedly deficient in vitamin C resulting from extremely limited food preferences. She presented with debilitating bone pain, inflammatory gingival disease, perifollicular hyperkeratosis, and purpura. Severe hypertension without another apparent secondary cause was also present, which has been previously undescribed. The signs of scurvy and hypertension resolved after treatment with vitamin C. The diagnosis of scurvy is made on clinical and radiographic grounds, and may be supported by finding reduced levels of vitamin C in serum or buffy-coat leukocytes. The response to vitamin C is dramatic. Clinicians should be aware of this potentially fatal but easily curable condition that is still occasionally encountered among children.

Radiologic diagnosis of Moller-Barlow disease (scurvy). Apropos of a case]
An Esp Pediatr. 1991 Mar;34(3):243-6. Spanish. No abstract available.
Scherzer E.

Kleiner HJ.
No Abstract [Clinical aspects of scurvy]
Dtsch Gesundheitsw. 1971 Nov 4;26(45):2133-5. German. No abstract available.

Wechsler B, Gatfosse M, Cabane J, Mouthon JM, Godeau P.

Abstract [A case of purpura, or the return to natural diseases]
Sem Hop. 1984 Jan 12;60(1):21-4. French.

Chaudhry SI, Newell EL, Lewis RR, Black MM.

Scurvy: a forgotten disease.
Clin Exp Dermatol. 2005 Nov;30(6):735-6. No abstract available.

Gabay C, Voskuyl AE, Cadiot G, Mignon M, Kahn MF.

Abstract A case of scurvy presenting with cutaneous and articular signs.
Clin Rheumatol. 1993 Jun;12(2):278-80.

Heymann WR.
Scurvy in children.
J Am Acad Dermatol. 2007 Aug;57(2):358-9. Review.
:
Salvi A, Coppini A, Lazzaroni G, Manganoni A.
Abstract A case of vascular purpura with scurvy.
Recenti Prog Med. 1992 Nov;83(11):652-3.

Kasa RM.
Vitamin C: from scurvy to the common cold.
Am J Med Technol. 1983 Jan;49(1):23-6. Review.

Nienhuis AW.
Vitamin C and iron.
N Engl J Med. 1981 Jan 15;304(3):170-1. No abstract available.

Vairo G, Salustri A, Trambaiolo P, D'Amore F.
Scurvy mimicking systemic vasculitis.
Minerva Med. 2002 Apr;93(2):145-50. English, Italian.

Touyz LZ.
Vitamin C, oral scurvy and periodontal disease.
S Afr Med J. 1984 May 26;65(21):838-42. Review.

Khonsari H, Grandiere-Perez L, Caumes E.
[Scurvy, a re-emerging disease]
Rev Med Interne. 2005 Nov;26(11):885-90. Review. French.

Weinstein M, Babyn P, Zlotkin S.
An orange a day keeps the doctor away: scurvy in the year 2000.
Pediatrics. 2001 Sep;108(3):E55.

Gomez-Carrasco JA, Lopez-Herce Cid J, Bernabe de Frutos C, Ripalda-Crespo MJ, Garcia de Frias JE.
Scurvy in adolescence.
J Pediatr Gastroenterol Nutr. 1994 Jul;19(1):118-20. No abstract available.

Monks G, Juracek L, Weigand D, Magro C, Cornelison R, Crowson AN.
A case of scurvy in an autistic boy.
J Drugs Dermatol. 2002 Jul;1(1):67-9.

Pediatria (Napoli). 1983 Jun-Sep;91(2-3):251-60.
[Clinico-radiologic studies of a case of scurvy in an infant]
[Article in Italian]

Tolone C, Santinelli R, Salvi V, Toraldo R, Di Lena C, D'Avanzo M.
Zhonghua Fang She Xue Za Zhi. 1987 Apr;21(2):69-74.
[X-ray manifestations of scurvy and its pathological basis (report of 70 cases)]
[Article in Chinese]

Wang YZ.
Am J Dis Child. 1979 Mar;133(3):323-4.
Radiological case of the month. Scurvy: almost historic, but not quite.
Young LW, Schiliro G, Russo A.

Brickley M, Ives R.
Skeletal manifestations of infantile scurvy.
Am J Phys Anthropol. 2006 Feb;129(2):163-72.

Ramar S, Sivaramakrishnan V, Manoharan K.
Abstract Scurvy--a forgotten disease.
Arch Phys Med Rehabil. 1993 Jan;74(1):92-5.

De DC, Bhattacharyya AK.
Scurvy: report of a case with atypical radiological features.
Indian J Pediatr. 1968 Jan;35(240):34-5.

Monatsschr Kinderheilkd. 1984 Apr;132(4):240-1.
[Infantile scurvy]
[Article in German] von Mühlendahl KE.

Infantile scurvy, today a rare disease, can be diagnosed either by recognition of a characteristic constellation of clinical features, or on the correct interpretation of nearly pathognomonic radiological signs. Dystrophy, recurrent infections, fever, anemia, hemorrhagic effusions, hematuria, tenderness of the legs, pseudo-paralysis and "frog position" and costochondral swelling or angulation are frequent signs. Radiologically, thickening of the epiphyseal plate ("scurvy line") and subepiphyseal rarefication , general osteoporosis and subperiostal hemorrhage are important diagnostic clues.

Arch Pediatr Adolesc Med. 2001 May;155(5):607-8.
Special feature: picture of the month. Infantile scurvy.
Riepe FG, Eichmann D, Oppermann HC, Schmitt HJ, Tunnessen WW Jr.
Department of Pediatrics, Christian Albrechts University Kiel, Germany.

Med J Aust. 1970 Jan 24;1(4):187.
Scurvy amongst central Australian Aboriginal children.
Kirke DK, Vorbach EA, Newman DM.

Pediatr Ann. 1983 Dec;12(12):894-903.Links
The battered child syndrome: pitfalls in radiological diagnosis.
Radkowski MA.

An Esp Pediatr. 1991 Mar;34(3):243-6.Links
[Radiologic diagnosis of Möller-Barlow disease (scurvy). Apropos of a case]
[Article in Spanish]

Burches Greus E, Lecuona López C, Ardit Lucas J, Aguilar Bacallado F, García Vicent C, Tomás Ratés C, Alvarez Angel Donderis Folgado P.

Servicio de Pediatría, Hospital General Universitario de Valencia. Z Arztl Fortbild (Jena). 1966 Nov 15;60(21):1221-3.Links
[Möller-Barlow disease in twins. A contribution to infantile scurvy]
[Article in German] Hagedorn C.

Int Z Vitaminforsch Beih. 1957;27(3):265-74.
[Möller-Barlow's disease, scurvy (vitamin C deficiency) in infants.]
[Article in German] GLANZMANN E.

: Pediatr Int. 2002 Feb;44(1):37-42.Click here to read Links

Comment in:
Pediatr Int. 2003 Apr;45(2):220.
Pediatr Int. 2003 Dec;45(6):758.

Unexplained subdural hematoma in young children: is it always child abuse?
Fung EL, Sung RY, Nelson EA, Poon WS.

Department of Paediatrics, Faculty of Medicine, 6/F Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. b300875@mailserv.cuhk.edu.hk

BACKGROUND: In the published reports of the developed society, subdural hematoma and/or retinal hemorrhages, in the absence of documented history of major trauma, should be considered diagnostic of child abuse. Many people used the above criteria for diagnosis, but subsequently found that retinal hemorrhages were more common in non-accidental injuries (NAI). To what extent is the proposed pathognomonic association between unexplained subdural hematoma/retinal hemorrhages and child abuse a self-fulfilling prophecy? METHODS: Clinical details of nine children under 2 years with unexplained subdural hematoma admitted to Prince of Wales Hospital between 1995 and 1998 were reviewed. RESULTS: Four had no other physical signs of injury, five had retinal hemorrhages and one had multiple bruises over the body. Following multidisciplinary case conferences for seven children, a diagnosis of NAI was concluded in four cases, but in no case could the abuser be definitely identified. Clinical outcome was poor with seven children showing either profound disability (n = 5) or evidence of developmental delay (n = 2). CONCLUSION: In this series, NAI were not established in three of the seven cases. Did we underdiagnose child abuse in these cases? Despite a magnitude of opinion to the contrary, the issue of whether "trivial" head injury can cause subdural hemorrhages and/or retinal hemorrhages is yet unresolved. Clearly much more information on this very sensitive and serious issue is required and these data should be collected with an open mind.
Thromb Diath Haemorrh Suppl. 1968;30:145-5.

[Vitamin C deficiency--scurvy and Moeller-Barlow's disease]
[Article in German] Winckelmann G.

Eur J Pediatr. 2004 Jul;163(7):420-1. Epub 2004 Apr 9.Click here to read Links
An infant with methylmalonic aciduria and homocystinuria (cblC) presenting with retinal haemorrhages and subdural haematoma mimicking non-accidental injury.
Francis PJ, Calver DM, Barnfield P, Turner C, Dalton RN, Champion MP.

Eye Department, Guys Hospital, London, UK.

J R Soc Med. 2000 Nov;93(11):591-2.
Hermansky-Pudlak syndrome presenting with subdural haematoma and retinal haemorrhages in infancy.
Russell-Eggitt IM, Thompson DA, Khair K, Liesner R, Hann IM.

Department of Ophthalmology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. isabelle-re@dial.pipex.com

Clin Pediatr (Phila). 1966 Apr;5(4):230-7.
A "pseudo" battered child.
Berant M, Jacobs J.

Thromb Diath Haemorrh Suppl. 1968;30:145-5.
[Vitamin C deficiency--scurvy and Moeller-Barlow's disease]
[Article in German]

Winckelmann G. Thromb Diath Haemorrh Suppl. 1968;30:145-5.
[Vitamin C deficiency--scurvy and Moeller-Barlow's disease]
[Article in German]

Winckelmann G.Dtsch Zahnarztl Z. 1968 Dec;23(12):1422-4.Links
[On cases of infantile scurvy (Moeller-Barlow's disease) and of scorbutoid diseases (mixed forms) in infants]
[Article in German]

Spier JP. Br Med J (Clin Res Ed). 1983 Dec 17;287(6408):1862-3.
Infantile scurvy: the centenary of Barlow's disease.
Evans PR.

Med Arts Sci. 1967 Jan-Apr;21(1):9-22.Links
The incidence of infantile scurvy. A problem of yesteryear and today.
Vyhmeister IB.

Spier JP.
[On cases of infantile scurvy (Moeller-Barlow's disease) and of scorbutoid diseases (mixed forms) in infants]
Dtsch Zahnarztl Z. 1968 Dec;23(12):1422-4. German. No abstract available.

RASMUSSEN KO.
[Moeller-Barlow's disease, infantile scurvy; review with 2 case reports.]
Ugeskr Laeger. 1954 Aug 23;116(34):1223-8. Danish. No abstract available.

Meinecke R, Bannert N, Schmerse G.
Moeller-Barlow's disease. Clinical picture and surgical treatment of extremly dislocated femoral epiphyses]
Z Orthop Ihre Grenzgeb. 1970 Sep;108(2):286-93. German. No abstract available.

Evans PR.
Infantile scurvy: the centenary of Barlow's disease.
Br Med J (Clin Res Ed). 1983 Dec 17;287(6408):1862-3.

Falconer DT.
Scurvy presenting with oral symptoms. A case report.
Br Dent J. 1979 May 15;146(10):313-4. No abstract available.

Scherzer E.
[Still existing infantile scurvy. Case report on Moller-Barlow's disease]
Munch Med Wochenschr. 1968 Mar 1;110(9):535-40. German. No abstract available.

POLANSKA B.

[Infantile scurvy, Barlow's disease.]
Pol Przegl Radiol. 1956 Jul-Aug;20(4):217-22. Polish. No abstract available.
PMID: 13388806 [PubMed - indexed for MEDLINE]
8:
Clemetson CA.
Barlow's disease.
Med Hypotheses. 2002 Jul;59(1):52-6.
PMID: 12160680 [PubMed - indexed for MEDLINE]
9:
GLANZMANN E.
[Moller-Barlow's disease, scurvy (vitamin C deficiency) in infants.]
Int Z Vitaminforsch Beih. 1957;27(3):265-74. German.
PMID: 13428384 [PubMed - indexed for MEDLINE]
10:
Winckelmann G.
[Vitamin C deficiency--scurvy and Moeller-Barlow's disease]
Thromb Diath Haemorrh Suppl. 1968;30:145-5. German. No abstract available.
PMID: 4269136 [PubMed - indexed for MEDLINE]
11:
Blancher G.
[Treatment of infantile scurvy or Barlow's disease]
Cah Coll Med Hop Paris. 1968 Feb;9(2):188-94. French. No abstract available.
PMID: 5745278 [PubMed - indexed for MEDLINE]
12:
Schimke E, Seidel H, Grunbaum EG, Bornert D.
[Clinical, laboratory diagnostic, electrophonocardiographic, and roentgenologic studies with consideration of the ACTH test in Moller-Barlow's disease and acropachy of the dog. I. Moller-Barlow's disease]
Wien Tierarztl Monatsschr. 1967 Oct;54(10):650-63. German.
PMID: 4305081 [PubMed - indexed for MEDLINE]
13:
BENEDETTI GB, CANEPA G, PELIZZA A.
[THE MOELLER-BARLOW DISEASE. CLINICO-RADIOGRAPHIC AND ANATOMO-PATHOLOGIC CONSIDERATIONS ON 12 CASES OF INFANTILE SCURVY.]
Chir Organi Mov. 1964;53:112-59. Italian.
PMID: 14214242 [PubMed - indexed for MEDLINE]
14:
TUMAY SB.
[Severe scurvy (Moeller-Barlow disease) associated with a bone disorder.]
Istanbul Tip Fak Mecmuasi. 1959;22:186-208. Turkish.
PMID: 13839814 [PubMed - indexed for MEDLINE]
15:
Rowland RW.
Abstract Necrotizing ulcerative gingivitis.
Ann Periodontol. 1999 Dec;4(1):65-73; discussion 78. Review.
PMID: 10863376 [PubMed - indexed for MEDLINE]
16:
TORRES UMANA C.
[Barlow's disease in Bogota.]
Rev Colomb Pediatr Pueric. 1950 Apr;9(4):120-9. Undetermined Language. No abstract available.
PMID: 15430734 [PubMed - indexed for MEDLINE]
17:
CHEVALLEY, FEVRE, NOUAILLE, POINTEAU, VILAIN.
[Case of Barlow's disease with epiphyseal detachment.]
Arch Fr Pediatr. 1950;7(6):588-90. Undetermined Language. No abstract available.
PMID: 14790839 [PubMed - indexed for MEDLINE]
18:
DE ALZAGA S, VEGA DE GANDOLFO HERRERA AM, MONACO J, LOMBARDI Q.
[Barlow's disease.]
Dia Med. 1954 Jun 24;26(42):1110-3. Spanish. No abstract available.
PMID: 13191224 [PubMed - indexed for MEDLINE]
19:
RADDEN BG, READE PC.
Acute gingivitis and dermatitis of scorbutic origin.
Oral Surg Oral Med Oral Pathol. 1963 Feb;16:236-45. No abstract available.
PMID: 13972954 [PubMed - indexed for MEDLINE]
20:
Schmidt LJ, Davis CC.
Acute necrotizing ulcerative gingivitis: clinical features, etiology and treatment.
Dent Hyg (Chic). 1984 Jan;58(1):20-4.
PMID: 6585327 [PubMed - indexed for MEDLINE]

1: Pol Przegl Radiol. 1956 Jul-Aug;20(4):217-22.
[Infantile scurvy, Barlow's disease.]
[Article in Polish]

POLANSKA B.

PMID: 13388806 [PubMed - indexed for MEDLINE]

: Cah Coll Med Hop Paris. 1968 Feb;9(2):188-94.Links
[Treatment of infantile scurvy or Barlow's disease]
[Article in French]

Blancher G.

PMID: 5745278 [PubMed - indexed for MEDLINE]

1: Pediatr Radiol. 1976 Feb 13;4(2):122-3.
Epiphyseo-metaphyseal cupping following infantile scurvy.
Sprogue PL.

A five year old girl presented with short femora, cupped distal metaphyses and flexion deformity of the knees suggesting previous epiphyseo-metaphyseal damage. The aetiology was suggested by finding a history of previous infantile scurvy with separated distal femoral epiphyses. The rarity of this complication and possible contributing factors are discussed.

PMID: 967570 [PubMed - indexed for MEDLINE]

1: Indian Pediatr. 1999 Oct;36(10):1067
Scurvy persists in the current era.
Paul DK, Lahiri M, Garai TB, Chatterjee MK.

PMID: 10745326 [PubMed - indexed for MEDLINE]

1: Pol Przegl Radiol. 1956 Jul-Aug;20(4):217-22.Links
[Infantile scurvy, Barlow's disease.]
[Article in Polish]

POLANSKA B.

PMID: 13388806 [PubMed - indexed for MEDLINE]

RIBS

Mase K.
[Scurvy, Moller-Barlow disease]
Ryoikibetsu Shokogun Shirizu. 1998;(21 Pt 2):405-7. Review. Japanese. No abstract available.
PMID: 9833527 [PubMed - indexed for MEDLINE]
2:
Burches Greus E, Lecuona Lopez C, Ardit Lucas J, Aguilar Bacallado F, Garcia Vicent C, Tomas Rates C, Alvarez Angel V, Donderis Folgado P.
[Radiologic diagnosis of Moller-Barlow disease (scurvy). Apropos of a case]
An Esp Pediatr. 1991 Mar;34(3):243-6. Spanish. No abstract available.
PMID: 2064156 [PubMed - indexed for MEDLINE]
3:
Stolyhwo-Suchanek A, Sloma-Walejko B, Zawistowska E.
[Moller-Barlow disease and Jaksch-Hayem anemia in 2 infants from twin pregnancies]
Pediatr Pol. 1968 Nov;43(11):1399-402. Polish. No abstract available.
PMID: 5710791 [PubMed - indexed for MEDLINE]
4:
Hagedorn C.
[Moller-Barlow disease in twins. A contribution to infantile scurvy]
Z Arztl Fortbild (Jena). 1966 Nov 15;60(21):1221-3. German. .
PMID: 5990877 [PubMed - indexed for MEDLINE]
5:
Brunelli G, Mariotti A.
[Contribution to the knowledge of Moller-Barlow disease]
Clin Pediatr (Bologna). 1966 Feb;48(2):65-72. Italian. No abstract available.
PMID: 5955612 [PubMed - indexed for MEDLINE]
6:
AUGUSZTIN V.
[Case of Moller-Barlow disease.]
Orv Hetil. 1953 Nov 22;94(47):1311-2. Undetermined Language.
PMID: 13133445 [PubMed - indexed for MEDLINE]

1: Am J Phys Anthropol. 2006 Feb;129(2):163-72.
Skeletal manifestations of infantile scurvy.
Brickley M, Ives R.

Institute of Archaeology and Antiquity, School of Historical Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. M.B.Brickley@bham.ac.uk

Recent investigations of human skeletal material from the historic St. Martin's cemetery, England, found a range of abnormal lesions in six infants that are almost certainly related to scurvy. Porous and proliferative bone lesions affecting the cranial bones and scapulae were found, and this paper presents images obtained using both macroscopic and scanning electron microscope examination of the lesions. Previous work on infantile scurvy (Ortner et al., 1997-2001) relied heavily on changes at the sphenoid, which is often missing in archaeological bone, so the identification of changes attributable to scurvy on other cranial bones and the scapulae is encouraging. The ability to recognize changes related to scurvy on a range of bones will ensure an enhanced potential for recognition of this disease in future research involving archaeological bone. Research on historical documents from Birmingham dating to the eighteenth and nineteenth centuries, combined with the probable cases of scurvy identified, supports the view that the paucity of cases of infantile scurvy from the archaeological record reflects a lack of understanding and recognition of bone manifestations, rather than a lack of occurrence in this period. Changes linked to scurvy were only found in infants from the poorer sections of the community from St. Martin's, and this is almost certainly linked to patterns of food consumption and may be related to shortages of potatoes, due to blight, experienced during this period.

PMID: 16323179 [PubMed - indexed for MEDLINE]

1: Istanbul Tip Fak Mecmuasi. 1959;22:186-208. Related Articles, Links

[Severe scurvy (Moeller-Barlow disease) associated with a bone disorder.]

[Article in Turkish]

TUMAY SB.

http://archpedi.ama-assn.org/cgi/content/full/155/5/607 (go to external site for photos)

Vol. 155 No. 5, May 2001 TABLE OF CONTENTS
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Special Feature

Picture of the Month

Felix G. Riepe, MD; Dirk Eichmann, MD; Hans C. Oppermann, MD; Heniz J. Schmitt, MD; Walter W. Tunnessen, Jr, MD
From the Departments of Pediatrics (Drs Riepe, Eichmann, and Schmitt) and Diagnostic Radiology (Dr Opperman), Faculty of Medicine, Christian Albrechts University Kiel, Kiel, Germany; and the American Board of Pediatrics, Chapel Hill, NC (Dr Tunnessen).

Arch Pediatr Adolesc Med. 2001;155:607-608.

A 15-MONTH-OLD boy had a history of unexplained bleeding from his gums for several weeks and fever for 2 days. He had been fed only cow's milk and oatmeal since age 4 months. On physical examination he had almost no spontaneous movement. His legs were held in a "frog leg" position (Figure 1), were swollen along the long bones, and were tender to palpation. His skin was dry and pale. Hemorrhages of the gingiva were obvious as were 2 blood-filled cysts of the lower canine teeth (Figure 2). The tympanic membranes were hyperemic, and evidence of middle-ear fluid was present. Palpable prominence of the costochondral junctions of the chest wall was noted.

Figure 1.

Figure 2.

The results of laboratory examinations revealed a normal white blood cell count, a hemoglobin level of 76 g/L, and a platelet count of 334 x 109/L. The serum calcium, phosphorous, copper, and alkaline phosphatase levels were normal. Thyroid stimulating hormone, triiodothyronine, and thyroxine levels were also normal. The serum level of vitamin D was normal, but vitamin C levels were low, 28 µmol/L (reference range, 45-108 µmol/L). Chest x-ray film showed a scorbutic rosary at the costochondral junctions with a "corner" sign noted in the proximal metaphysis of the humerus. Lower extremity radiographs demonstrated abnormalities (Figure 3).

Figure 3.

Denouement and Discussion: Infantile Scurvy

Figure 1. The infant initiated little spontaneous movement and held his legs slightly flexed and abducted.

Figure 2. The gingiva are spongy and bleeding with blood-filled cysts in both lower canine teeth.

Figure 3. A radiograph of the right lower extremity demonstrates osteoporosis with a "corner" sign at the distal femur and rings of ossification around the proximal tibia epiphysis and distal femoral epiphysis.

Infantile scurvy (Moeller-Barlow disease) is rarely reported in developed countries except in association with global malnutrition.1, 2, 3 The rarity of occurrence is responsible for the frequent delayed recognition of this disorder. A deficiency of vitamin C (ascorbic acid) is responsible for the manifestations of scurvy. Vitamin C is a cofactor for numerous enzymes that are critical to several body functions. The most common manifestations of scurvy are due to the decreased production and increased fragility of collagen, a result of faulty hydroxylation of proline and lysine in forming a precise triple-helical collagen structure.4, 5 Vitamin C also plays a number of roles in hematopoiesis, including the promotion of iron absorption and as a cofactor for the conversion of folic acid to folinic acid. Humans cannot synthesize vitamin C and must rely on intestinal absorption from ingested nutrients.

CLINICAL MANIFESTATIONS

Most cases of scurvy are seen between ages 6 and 24 months. Neonatal scurvy is rare, except in infants of mothers with extreme hypovitaminosis C.6, 7 Breast milk contains sufficient amounts of vitamin C unless the mother's diet is deficient in this vitamin.8 The first clinical manifestations of scurvy are often associated with acute febrile illnesses that seem to increase the need for vitamin C.

Initial manifestations of scurvy are vague and include irritability, decreased appetite, and delayed development. As effects of vitamin C deficiency progress, affected children lie still with little movement because of generalized tenderness, most apparent in bones as a result of subperiosteal hemorrhages. Swelling may be noted along the shafts of long bones. Pseudoparalysis may be apparent as a result of the bone pain. Infants often hold their legs in a "frog leg" position and dislike being handled, often refusing to walk.

Gingival hemorrhages may occur along with spongy, hemorrhagic swellings of the mucous membranes overlaying teeth. Petechial hemorrhages may occur in the skin spontaneously or, more commonly, below the site of tourniquet application, the Rumpel-Leede sign, as a manifestation of capillary fragility. Swelling may be palpated along the costochondral junctions of the rib cage, resembling the rosary seen in rickets.

RADIOGRAPHIC FINDINGS

Changes in the long bones, particularly around the knee, are most diagnostic of scurvy. The earliest finding is generalized demineralization with a ground-glass appearance to the bones. The cortex is thinned. A white line, so-called Fränkel sign, is apparent at the ends of metaphyses, representing widening of the provisional zones of calcification and its increased density. The epiphyseal centers show central rarefaction and are also surrounded by a white line of calcification, referred to as the Wimberger ring or halo-ossification center. Transverse bands of diminished density adjacent to the Fränkel sign are known as scurvy lines. Lateral metaphyseal spurs (corner sign) between the provisional zone of calcification and the cortex are the result of metaphyseal infarctions. The corner sign is more pathognomonic of scurvy than the other bony findings. Irregular calcification and widening of the costochondral junctions results in the scorbutic rosary. Periosteal hemorrhages cannot be detected on radiography in scurvy until they become calcified during healing.

DIFFERENTIAL DIAGNOSIS, DIAGNOSIS, AND TREATMENT

Bleeding manifestations and bone pain may suggest acute leukemia. Bone pain and refusal to walk may lead to consideration of osteomyelitis, septic arthritis, and rheumatic disorders.

The diagnosis of scurvy is based on a combination of clinical and radiographic findings. A dietary history compatible with insufficient intake of vitamin C should be present. Accurate laboratory measurement of vitamin C levels is difficult because of the instability of vitamin C.

Healing occurs rapidly with the oral administration of 100 to 200 mg/d of vitamin C. As healing occurs, the intake of vitamin C may be reduced to 50 mg/d until complete clinical and radiologic resolution has taken place.9

AUTHOR INFORMATION

Accepted for publication January 14, 2000.

Reprints: Felix G. Riepe, MD, Klinikum der Christian-Albrechts Universitit, Klinik far Allgemeine Pädiatrie, Schwanenweg 20, 24105 Kiel, Germany.

REFERENCES

1. Yilmaz S, Karademir S, Ertan U, et al. Scurvy: a case report. Turk J Pediatr. 1998;40:249-253. ISI | PUBMED
2. Najera-Martinez P, Rodriquez-Collado A, Gorian-Maldonado E. Scurvy: a study of 13 cases. Bol Med Hosp Infant Mex. 1992;49:280-285. PUBMED
3. Young LW, Schiliro G, Russo A. Radiological case of the month: scurvy: almost historic, but not quite. AJDC. 1979;133:323-324.
4. Gershoff SN. Vitamin C (ascorbic acid): new roles, new requirements? Nutr Rev. 1993;51:313-326. ISI | PUBMED
5. Halliwell B. Ascorbic acid: hype, hoax, or healer [editorial]? Am J Clin Nutr. 1997;65:1891-1892. FREE FULL TEXT
6. Clow CL, Laberge C, Scriver CR. Neonatal hypertyrosinemia and evidence for deficiency of ascorbic acid in arctic and subarctic peoples. CMAJ. 1975;113:624-626. ABSTRACT
7. Gómez DB, Warmann S, Scholl S, Glüer S. Neonatal scurvy [in German]. Monatsschr Kinderheilkd. 1999;147:570-572. FULL TEXT
8. Macy IG. Composition of human colostrum and milk. AJDC. 1949;78:589-594.
9. Moran JR, Greene HL. The B vitamins and vitamin C in human nutrition. AJDC. 1979;133:308-314.

SECTION EDITOR: WALTER W. TUNNESSEN, JR, MD

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