A 5-year-old boy with non-verbal autism, whose diet consisted solely of chicken and biscuits, was diagnosed with scurvy – a now rare condition that plagued sailors hundreds of years ago.
The diagnosis, caused by a vitamin C deficiency, was made after the boy visited an orthopaedic clinic.
The boy's condition and the circumstances around how he got it were detailed in the latest issue of the New Zealand Medical Journal.
The boy's parents took him to the clinic after noticing he had "significant discomfort" and reduced motion in his left leg. He also struggled to bear weight on the leg and felt tenderness around the upper left leg and knee.
He also had non-verbal autism spectrum disorder, which is associated with restricted eating.
Blood tests and an MRI were performed, and doctors eventually consulted a pediatric rheumatology and infectious diseases team.
In a further assessment, the boy was found to have swollen and bleeding gums, as well as a faint rash on his lower legs.
A check of the boy's history revealed his autism diagnosis with "avoidant/restrictive food intake".
The boy's diet consisted entirely of chicken and biscuits, with no fruit or vegetables.
He was diagnosed with scurvy and fed vitamin supplements through a nasogastric tube.
Over the next three to four days of inpatient therapy, the boy made a "marked clinical improvement" and was soon able to walk around.
After being discharged, with follow-up visits to community nursing and a dietitian, his rash disappeared, and his mobility improved.
Autism and food aversions often go hand in hand. According to the UK NHS, this can be caused by several factors, including food-related sensory processing, environment-related sensory processing, interoception, digestive issues, a need for routine and predictability, social factors, and emotional factors.
Scurvy is now largely a historical condition caused by a lack of vitamin C, which was a major limiting factor in long-distance sea travel hundreds of years ago, frequently killing sailors.
According to the NHS, symptoms of scurvy include feeling very tired and weak all the time; feeling irritable and sad all the time; joint, muscle or leg pain; swollen, bleeding gums (sometimes teeth can fall out); developing red or blue spots on the skin; and skin that bruises easily.
Untreated scurvy can cause serious problems and may even be life-threatening.
A cure to scurvy was found in 1747 when Scottish surgeon James Lind conducted a trial at sea, giving sailors oranges and lemons. With the discovery of vitamin C in 1928, the condition was conquered.
According to the US Naval Institute, scurvy killed two million sailors between the 16th and 18th centuries.
In modern times, scurvy most commonly occurs in neglected children, people with mental disabilities, those with unusual eating habits, alcoholics and older people who live alone.
The report's authors, Weisi Xia, Michaela Mullen, and Ryan Johnstone, said the boy's case showed the importance of dietary history when making assessments – especially for autistic and older patients in hospital.
“This case highlights that, although rare, scurvy should still be considered in New Zealand in at-risk populations.
"Early identification and treatment should be instituted, as the treatment is relatively simple.
"However, these vulnerable groups with food selectivity may require ongoing long-term nutritional supplementation to prevent recurrence."
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