Abstract
Severe ascorbic acid (Vitamin C) deficiency, commonly known as scurvy, continues to be a problem in malnourished populations across the world but is relatively rare in the United States. Early features of this condition include general weakness, fatigue, and aching limbs. An extremely rare and late feature of this condition is subgaleal hemorrhage. Scurvy has such a low prevalence in First World countries that it is often misdiagnosed or not diagnosed at all. The subject in this case report presented acutely and is one of few to involve a subgaleal hemorrhage to be documented in medical literature to date. Laboratory studies and clinical improvement through treatment established the diagnosis. Ascorbic acid deficiency should be considered when evaluating children with poor nutrition despite socioeconomic status, living conditions, or access to health care. This case also reminds us that neurodivergent children are a vulnerable population and more research will need to be conducted to determine just how detrimental the pandemic has been to patients with ongoing problems who were lost to follow up.
Author Contributions
Copyright© 2023
W. Glusman DO MAT Jennifer, et al.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests The authors have declared that no competing interests exist.
Funding Interests:
Citation:
Discussion
The mother of our patient has two children with severe non-verbal autism, which makes this case even more concerning; her children see physicians more often than children who are not neurodivergent, giving them more opportunities to be monitored closely for nutrition than most children. Many parents of children with autism spectrum disorder face challenges in providing a balanced diet for their children. Unfortunately, nutrition is often forgotten about for said patients as other medical concerns frequently take priority in a short office visit. The authors of this case report hope that this case reminds providers to discuss nutrition with parents of neurodivergent children early and often to gauge whether dietary requirements are being met. What cannot be ignored is how much more at risk neurodivergent children were during the pandemic due to a national shortage of medical services. With no access to speech therapy for several years, this patient was lost to follow up and greatly suffered the consequences. There is very little literature on how detrimental the pandemic was to patients with ongoing medical problems. More research needs to be conducted to determine how far behind these children are in developmental milestones and nutrition, and what interventions will be needed to catch them up. Ultimately, encouraging open and honest communication between providers and parents will help to prevent severe nutritional deficiencies and the devastating consequences they can have, as seen in this case report. Broaching the topic of nutrition with a caring and judgement-free approach will encourage more honesty between parents and providers and lead to better outcomes for neurodivergent children everywhere.