Scurvy — DTM&H MCQ

Correct answer: E — Scurvy

The correct answer is E, scurvy. This child has the classic tetrad of vitamin C deficiency: bleeding, swollen gums, perifollicular haemorrhages, painful limbs, and subperiosteal haemorrhages on radiographs, following four months without fresh fruit or vegetables. Vitamin C is a cofactor for prolyl and lysyl hydroxylase in collagen synthesis; deficiency weakens capillary walls, periosteum and connective tissue, producing the mucocutaneous bleeding and painful subperiosteal haematomas seen here. Refugee and displaced populations with restricted diets are a recognised at-risk group, and the combination of dietary history plus radiological subperiosteal haemorrhage is pathognomonic enough to make the diagnosis clinically, with rapid response to ascorbic acid replacement confirming it. Why the other options are wrong: D. Acute leukaemia: causes bruising and bone pain from marrow infiltration, but would show cytopenias, blast cells or hepatosplenomegaly on blood film, and gum swelling reflects leukaemic infiltration rather than perifollicular haemorrhage; the specific dietary history here points away from malignancy. B. Rickets: results from vitamin D or calcium deficiency causing defective bone mineralisation, giving bowing, widened wrists and craniotabes, not gum bleeding or perifollicular haemorrhages, and radiographs show cupping and fraying of metaphyses rather than subperiosteal haemorrhage. A. Vitamin K deficiency: impairs clotting factors II, VII, IX and X, causing mucosal or intracranial bleeding, but does not cause perifollicular haemorrhages, gum hypertrophy or subperiosteal bleeding, and is not linked to prolonged lack of fresh fruit. C. Henoch-Schonlein purpura: produces palpable purpura, abdominal pain and arthralgia from IgA vasculitis, but lacks the specific dietary trigger, gum changes and radiological subperiosteal haemorrhage seen in scurvy. Key point: Perifollicular haemorrhage plus swollen bleeding gums plus subperiosteal haemorrhage after prolonged lack of vitamin C intake is diagnostic of scurvy, reflecting defective collagen synthesis.

Reference: Patient.info (Professional Reference), Vitamin C Deficiency (Scurvy), https://patient.info/doctor/vitamin-c-deficiency-pro