Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs
<b>Background:</b> Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteri...
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MDPI AG
2025-05-01
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| Online Access: | https://www.mdpi.com/2227-9067/12/5/642 |
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| author | Lisa Gamalero Anna Perrone Chiara Macucci Alessandra Meneghel Marta Balzarin Sandra Trapani Giuseppe Indolfi Giorgia Martini Teresa Giani |
| author_facet | Lisa Gamalero Anna Perrone Chiara Macucci Alessandra Meneghel Marta Balzarin Sandra Trapani Giuseppe Indolfi Giorgia Martini Teresa Giani |
| author_sort | Lisa Gamalero |
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| description | <b>Background:</b> Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring radiological investigations. <b>Objective:</b> This study aims to describe the radiological signs of scurvy on pelvic magnetic resonance imaging (MRI) in children presenting with musculoskeletal symptoms and to highlight features that may help differentiate it from other conditions with similar presentations. <b>Methods:</b> We conducted a retrospective study including children admitted for musculoskeletal symptoms requiring a pelvic MRI and who were subsequently diagnosed with scurvy. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. <b>Results:</b> We identified ten patients with a median age at disease onset of 45 months (range 17–133 months) admitted between 2016 and 2022. All ten patients included in the study were male. All had at least one of the following symptoms: limping, pain in the lower limbs, or refusal to walk, in addition to gum bleeding (7/10), hypertrophic gums (5/10), purpura (3/10), irritability (3/10), and fever (2/10). In all patients, pelvic MRI showed a bilateral, patchy, abnormal, water-like signal intensity pattern in the sacroiliac area. Sacroiliitis was detected in three children and hip effusion in another child. Seven out of these ten patients had a previous pelvis X-ray that was negative. <b>Conclusions:</b> In scurvy, the pelvis is often prematurely affected, with bone marrow accumulating water and joints showing inflammatory changes, particularly at the hips and sacroiliac joints. Due to its ability to assess soft tissues and its high sensitivity to water content, MRI is the ideal imaging tool to assess these changes. In contrast, plain radiography is less sensitive and specific and may be uninformative in the early stages of the disease. |
| format | Article |
| id | doaj-art-8d4c02f5bf684243898122dc22eaa2a0 |
| institution | OA Journals |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj-art-8d4c02f5bf684243898122dc22eaa2a02025-08-20T02:33:38ZengMDPI AGChildren2227-90672025-05-0112564210.3390/children12050642Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging SignsLisa Gamalero0Anna Perrone1Chiara Macucci2Alessandra Meneghel3Marta Balzarin4Sandra Trapani5Giuseppe Indolfi6Giorgia Martini7Teresa Giani8Paediatric Division, ULSS2 Marca Trevigiana, Conegliano Hospital, 31015 Conegliano, ItalyRadiology Unit, AOU Meyer IRCCS, 50139 Florence, ItalyDepartment of Pediatrics, AOU Meyer IRCCS, 50139 Florence, ItalyDepartment of Woman’s and Child’s Health, University of Padua, 35122 Padua, ItalyPediatric Unit, “San Bortolo” Hospital, 36100 Vicenza, ItalyDepartment of Pediatrics, AOU Meyer IRCCS, 50139 Florence, ItalyDepartment of Pediatrics, AOU Meyer IRCCS, 50139 Florence, ItalyPaediatric Division, Academic Hospital of Udine, 33100 Udine, ItalyDepartment of Pediatrics, AOU Meyer IRCCS, 50139 Florence, Italy<b>Background:</b> Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring radiological investigations. <b>Objective:</b> This study aims to describe the radiological signs of scurvy on pelvic magnetic resonance imaging (MRI) in children presenting with musculoskeletal symptoms and to highlight features that may help differentiate it from other conditions with similar presentations. <b>Methods:</b> We conducted a retrospective study including children admitted for musculoskeletal symptoms requiring a pelvic MRI and who were subsequently diagnosed with scurvy. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. <b>Results:</b> We identified ten patients with a median age at disease onset of 45 months (range 17–133 months) admitted between 2016 and 2022. All ten patients included in the study were male. All had at least one of the following symptoms: limping, pain in the lower limbs, or refusal to walk, in addition to gum bleeding (7/10), hypertrophic gums (5/10), purpura (3/10), irritability (3/10), and fever (2/10). In all patients, pelvic MRI showed a bilateral, patchy, abnormal, water-like signal intensity pattern in the sacroiliac area. Sacroiliitis was detected in three children and hip effusion in another child. Seven out of these ten patients had a previous pelvis X-ray that was negative. <b>Conclusions:</b> In scurvy, the pelvis is often prematurely affected, with bone marrow accumulating water and joints showing inflammatory changes, particularly at the hips and sacroiliac joints. Due to its ability to assess soft tissues and its high sensitivity to water content, MRI is the ideal imaging tool to assess these changes. In contrast, plain radiography is less sensitive and specific and may be uninformative in the early stages of the disease.https://www.mdpi.com/2227-9067/12/5/642hipjuvenile idiopathic arthritismagnetic resonance imagingsacroiliac jointsscurvyvitamin C |
| spellingShingle | Lisa Gamalero Anna Perrone Chiara Macucci Alessandra Meneghel Marta Balzarin Sandra Trapani Giuseppe Indolfi Giorgia Martini Teresa Giani Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs Children hip juvenile idiopathic arthritis magnetic resonance imaging sacroiliac joints scurvy vitamin C |
| title | Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs |
| title_full | Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs |
| title_fullStr | Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs |
| title_full_unstemmed | Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs |
| title_short | Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs |
| title_sort | hip involvement in pediatric scurvy early magnetic imaging signs |
| topic | hip juvenile idiopathic arthritis magnetic resonance imaging sacroiliac joints scurvy vitamin C |
| url | https://www.mdpi.com/2227-9067/12/5/642 |
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