http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080318/pdf/brmedj03628-0067e.pdf
Dec. 11, 1954 CORRESPONDENCE BRITISH
MEDICALJOURNAL p.1419
Infantile Scurvy
SIR,-We were most interested to see the comments on our article (Journal,
November 13, p. 1143) on infantile scurvy and the figures provided
by Dr. Frances Braid in her letter (Journal, November 20, p. 1232).
It may be true, as Dr. Braid states, that in 1941, when H. C. Cameron's
quoted statement was made, infantile scurvy had ceased
to exist. We ourselves did not and cannot comment on the incidence
in 1941. Our concern was to point out that
the attitude implicit in the quotation was a dangerous one to adopt.
It was one of our main difficulties to find whether infantile scurvy
is on the increase. Figures were very difficult to obtain, and Dr.
Braid's observation of a marked increase is of great importance.
If infantile scurvy is really on the increase, we would suggest
two causes. First, the continued change away from
breast-feeding to reliance on artificial feeding methods. Secondly,
an increasing lack of awareness of the necessity for additions to
the diet when artificial feeds are relied on. This is contributed
to by the fact that the possibility of infantile scurvy is in danger
of being forgotten by the profession.- We are, etc.,
Derby. GwYN HOWELLS.
West Cornwall. W. H. ST. JOHN-BROOKS.
http://www.kjronline.org/abstract/view_articletext.asp?year=2007&page=443
MR Imaging in a Child with Scurvy: a Case Report
Seung Woo Choi, MD, Sun-Won Park, MD, Young Se Kwon, MD, In Suk Oh,
MD, Myung Kwan Lim, MD, Won Hong Kim, MD, Chang Hae Suh, MD
Department of Radiology, College of Medicine, Inha University, Incheon
400-711, Korea
Korean Journal of Radiology;
2007 October; 8(5):443-447
"Musculoskeletal manifestations are present in
80% of patients with scurvy (2). Moreover, bone disease is a more
frequent manifestation of the condition in children than adults, as
is in our patient. The radiographic findings of pediatric or infantile
scurvy are as follows: a transverse metaphyseal line of increased
density, a transverse metaphyseal line of decreased density (scurvy
line), metaphyseal excrescences of the beaks, subepiphyseal infractions,
increased density of periostitis and epiphyseal shell with a central
lucency (Wimberger's sign of scurvy). The scurvy line reflects the
decrease in trabeculae and detritus in the junctional area of the
metaphysis. Moreover, the Wimberger's sign is a prominent thickened
provisional zone of calcification with atrophy of the central spongiosa
on pathology (6). Furthermore, the radiographic findings including
osteopenia, thick sclerotic metaphyseal line, metaphyseal excrescences
of beaks, subepiphyseal infraction and periostitis were observed on
the radiograph of our patient; however the scurvy line was not prominent.
The resolution of the metaphyseal abnormalities after vitamin C supplementation
was also consistent with radiographic findings of the healing stage
of scurvy. The large shells of periosteal bone are common radiographic
findings, particularly during the healing phase of disease (6), which
seem to result from periostitis as a result of a subperiosteal hematoma.
Because of the rarity and a lack of understanding of the MRI findings
of scurvy, the laboratory findings suggested an inflammatory condition
and we initially could not suspect the possibility of scurvy. Therefore,
the subsequent antibiotic therapy and operation for subperiosteal
fluid drainage were performed under the impression of osteomyelitis
and a subperiosteal abscess. Due to the unresponsiveness and further
progression of the disease despite antibiotic therapy, we then suspected
the possibility of scurvy or another metabolic disease.