Scurvy is a rare disease in developed countries. Risk groups include children with restricted diets, mainly patients who are autistic or have cerebral palsy. Furthermore, consumption of plant-based beverages has increased in recent years, especially in developed countries. When plant-based beverages are the exclusive diet in the first year of life and not consumed as a supplement to formula or breastfeeding, it can result in severe nutritional problems. We report a case of scurvy after exclusive intake of almond beverages and almond flour from 2.5 to 11.0 months of life. The patient was referred for pathologic fractures of the femur, irritability, and failure to thrive. He had typical radiologic signs of scurvy, such as osteopenia, cortical thinning, Wimberger ring, Frankel line, fracture, and periosteal reaction. Moreover, his plasmatic vitamin C level was very low. The child was diagnosed with scurvy and was started on vitamin C replacement therapy at a dose of 300 mg per day. Over the following 3 months, his general condition, the pain in the legs, and the radiologic features improved; the plasmatic vitamin C level was normalized; and the child started walking. In summary, this case demonstrates that scurvy is a new and severe complication of improper use of almond drinks in the first year of life. Manufacturers should indicate that these beverages are inappropriate for infants who consume a vitamin C–deficient diet.
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February 2016
Case Report|
February 01 2016
Improper Use of a Plant-Based Vitamin C–Deficient Beverage Causes Scurvy in an Infant
Isidro Vitoria, MD;
aHospital Universitario y Politécnico La Fe, Valencia, Spain; and
Address correspondence to Isidro Vitoria, MD, PhD, Unit of Nutrition and Metabolopathies, Hospital Universitario y Politécnico La Fe, Avda. Fernando Abril Martorell, 106, Valencia 46026, Spain. E-mail: vitoria_isi@gva.es.
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Berta López, MD;
Berta López, MD
aHospital Universitario y Politécnico La Fe, Valencia, Spain; and
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Jacinto Gómez, MD;
Jacinto Gómez, MD
aHospital Universitario y Politécnico La Fe, Valencia, Spain; and
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Carolina Torres, MD;
Carolina Torres, MD
bPediatric Department, Hospital Elda, Alicante, Spain
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María Guasp, MD;
María Guasp, MD
aHospital Universitario y Politécnico La Fe, Valencia, Spain; and
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Inmaculada Calvo, MD;
Inmaculada Calvo, MD
aHospital Universitario y Politécnico La Fe, Valencia, Spain; and
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Jaime Dalmau, MD
Jaime Dalmau, MD
aHospital Universitario y Politécnico La Fe, Valencia, Spain; and
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Address correspondence to Isidro Vitoria, MD, PhD, Unit of Nutrition and Metabolopathies, Hospital Universitario y Politécnico La Fe, Avda. Fernando Abril Martorell, 106, Valencia 46026, Spain. E-mail: vitoria_isi@gva.es.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2016) 137 (2): e20152781.
Article history
Accepted:
October 08 2015
Citation
Isidro Vitoria, Berta López, Jacinto Gómez, Carolina Torres, María Guasp, Inmaculada Calvo, Jaime Dalmau; Improper Use of a Plant-Based Vitamin C–Deficient Beverage Causes Scurvy in an Infant. Pediatrics February 2016; 137 (2): e20152781. 10.1542/peds.2015-2781
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