Pediatric Scurvy Presenting With Vertebral Insufficiency Fractures Mimicking Chronic Recurrent Multifocal Osteomyelitis in a Child With Autism Spectrum Disorder

07/09/2026

AI Summary

Pediatric scurvy can mimic chronic recurrent multifocal osteomyelitis clinically and on imaging, including vertebral compression fractures and multifocal marrow signal abnormalities.
Children with autism spectrum disorder and highly restrictive diets are at high risk; careful dietary assessment prevents unnecessary invasive investigations.
Serum vitamin C <0.1 mg/dL confirmed diagnosis; prompt vitamin C and nutritional rehabilitation produced rapid pain resolution and restored ambulation.

AI Summary

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).

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.

Basic summary

Cureus. 2026 Aug 7;18(8):e114135. doi: 10.7759/cureus.114135. eCollection 2026 Aug.

ABSTRACT

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.

PMID:42703464 | PMC:PMC13546737 | DOI:10.7759/cureus.114135

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