Dados do Trabalho

Título

ASCORBIC ACID DEFICIENCY SIMULATING A PERIPHERAL NEUROPATHY

Apresentação do caso único

Male, 2 years old, referred to the Child Neurology outpatient clinic of our Hospital due to progressive pain in the lower limbs and difficulty walking. During the neurological examination, hypotonia was observed in the lower limbs, decreased strength in them, in addition to changes in deep reflexes (patellar and achilleus). The child was then sent to hospitalization for diagnostic investigation. From a neurological point of view, a cerebrospinal fluid collection and magnetic resonance imaging of the skull and neuraxial were performed, both tests without findings that justified the condition, however, from a pediatric point of view, it was found that the patient had a history of food selectivity, low weight gain, in addition to skin and tooth enamel changes. Expanded investigation where hip x-ray showed radiopaque line on the epiphyseal plate of the femur and the blood count showed iron deficiency anemia. After all the findings, the hypothesis of a lack of vitamin C (Ascorbic Acid) was raised. Replacement was started with progressive clinical improvement and neurological symptoms.

Discussão

Vitamin C (ascorbic acid) deficiency, although more common during the period of great navigation, currently affects patients with significant food selectivity, generally associated with neurodevelopmental disorders or psychiatric disorders, mainly in developing countries. Symptoms include irritability, changes in the skin, teeth and tooth enamel, gingival hemorrhages, bone sensitivity, pseudoparalysis of the lower limbs and anemia secondary to iron malabsorption.

Comentários finais

It is noted that several of the findings were found in our patient, and the diagnosis can be confirmed by serum ascorbic acid measurement (although this may be falsely negative) or by clinical improvement after its replacement, as happened in our case.

Referências

KINLIN, L. M.; WEINSTEIN, M. Scurvy: old disease, new lessons. Paediatrics and international child health, v. 43, n. 4, p. 83–94, 2023.
Scurvy due to restrictive diet in a child with autism spectrum disorder. Case report. Archivos argentinos de pediatria, v. 116, n. 5, 2018.
SWED-TOBIA, R. et al. Highly selective eating in autism spectrum disorder leading to scurvy: A series of three patients. Pediatric neurology, v. 94, p. 61–63, 2019.

Palavras Chave

ASCORBIC-ACID-DEFICIENCY; PERIPHERAL-NEUROPATHY; SCURVY