Differentials
Systemic vasculitis
SIGNS / SYMPTOMS
Vasculitis may present similarly (e.g., with constitutional symptoms), but with additional low-grade fever.
INVESTIGATIONS
Examination of inflammatory blood markers (e.g., erythrocyte sedimentation rate, CRP, and others) might suggest an inflammatory disorder such as vasculitis, as opposed to scurvy, in which inflammatory markers should be normal in the absence of concomitant infection. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Haematological malignancy
SIGNS / SYMPTOMS
Dermatological findings on the lower legs and ankles are less likely.
INVESTIGATIONS
Examination of FBC or peripheral blood smear should be normal in scurvy but might suggest leukaemia/lymphoma in the appropriate context. Bone marrow biopsy would provide further supportive evidence. A radionuclide bone scan is unremarkable in patients with scurvy, but abnormal in haematological malignancy. Therefore, this test is helpful in distinguishing between the two conditions when an MRI scan is abnormal. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Meningococcaemia
SIGNS / SYMPTOMS
Associated with fever or meningismus.
INVESTIGATIONS
FBC may be consistent with infection in this condition but should only reveal anaemia in patients with scurvy.
Cultures of blood or cerebrospinal fluid may yield meningococcus. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Gonococcaemia
SIGNS / SYMPTOMS
Associated with fever or meningismus.
INVESTIGATIONS
FBC may be consistent with infection in this condition but should only reveal anaemia in patients with scurvy.
Blood cultures may yield gonococcus. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Rocky Mountain spotted fever
SIGNS / SYMPTOMS
Associated with fever or meningismus.
INVESTIGATIONS
Specific tests for Rocky Mountain spotted fever are unreliable early in the disease. An indirect fluorescent antibody test completed after the first 5 days of symptoms is diagnostic. Before treatment, a skin biopsy can establish a diagnosis as well. A rickettsial blood culture is only available in research centres but is highly accurate. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Ecthyma gangrenosum
SIGNS / SYMPTOMS
Associated with fever or meningismus.
INVESTIGATIONS
FBC may be consistent with infection in this condition but should only reveal anaemia in patients with scurvy. If systemic symptoms are present, a blood culture for pseudomonas should be completed. Also, a Gram stain and culture on soft tissue or drainage to identify pseudomonas or other water bacteria is warranted. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Child abuse or other blunt trauma
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
Radiographic findings may aid in diagnosis, typically showing fractures at varying stages of healing in victims of abuse. On x-ray, scurvy shows irregularities and microfractures at the metaphysis and growth plate of the knee and wrist. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Disseminated intravascular coagulation
SIGNS / SYMPTOMS
Associated with fever or severe hypotension. However, these may be symptoms of scurvy with concomitant infection.
INVESTIGATIONS
FBC may be consistent with infection in this condition but should only reveal anaemia in scurvy. In early disseminated intravascular coagulation, prothrombin time (PT) and partial thromboplastin time (PTT) may be prolonged, platelet count low, with elevated D-dimer and plasma degradation products, and reduced plasma factors V and VIII. Later in disease, PT, PTT, and plasma factors normalise, with consistently high D-dimer and plasma degradation products. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Idiopathic thrombotic purpura
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
Scurvy is associated with normal platelet count. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Thrombotic thrombocytopenic purpura
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
Scurvy is associated with normal platelet count. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Aspirin overdose
SIGNS / SYMPTOMS
History should differentiate.
INVESTIGATIONS
The plasma salicylate concentration of 724-2172 micromol/L (10-30 mg/dL or 100-300 microgram/mL) determines aspirin usage and a level above 2896 micromol/L (above 40 mg/dL or 400 microgram/mL) indicates toxicity. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Cryoglobulinaemia
SIGNS / SYMPTOMS
Cryoglobulinaemia often displays erythematous macules or purpuric papules of the lower extremities and bloody crusts and ulcers. Raynaud's phenomenon may be present as well.
INVESTIGATIONS
Laboratory demonstration of serum cryoglobulins indicates cryoglobulinaemia. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Waldenstrom's macroglobulinaemia
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
A bone marrow smear shows a specific pattern (10% or greater WBCs with plasma cell differentiation with intertrabecular pattern) in Waldenstrom's macroglobulinaemia. Serum IgM level is high as well. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Autoerythrocyte sensitisation
SIGNS / SYMPTOMS
Autoerythrocyte sensitisation is associated with extreme emotional stress.
INVESTIGATIONS
Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Ehlers-Danlos syndrome
SIGNS / SYMPTOMS
Diagnosis suggested by joint laxity.
INVESTIGATIONS
Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Osteogenesis imperfecta
SIGNS / SYMPTOMS
Blue sclera and propensity for fractures.
INVESTIGATIONS
Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Pseudoxanthoma elasticum
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Systemic amyloidoses
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
Diagnosis is established by biopsy of an affected organ; microscopy with polarised light reveals green birefringence with Congo red staining; other microscopical techniques may yield similar results. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Henoch-Schonlein purpura
SIGNS / SYMPTOMS
Pruritus.
INVESTIGATIONS
Anaemia is rare in Henoch-Schonlein purpura. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Goodpasture's syndrome
SIGNS / SYMPTOMS
There may be pulmonary and renal involvement.
INVESTIGATIONS
Elevated anti-neutrophil cytoplasmic antibodies are not found in scurvy. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Menkes' disease
SIGNS / SYMPTOMS
Features include white hair colour, early retardation in growth, developmental delay, seizures, and focal cerebral and cerebellar degeneration. Perhaps the only genetic syndrome to be mistaken for scurvy.
INVESTIGATIONS
Menkes' heterozygotic carriers may have similar changes in long bone metaphyses.[68] Low serum copper (<11 micromol/L; <70 mg/dL) and serum ceruloplasmin (<200 mg/L) are found in Menkes'. On microscopical examination of hair, a specific finding of pili torti is found in Menkes' as well. Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
Acquired limp or limb pain in a child
SIGNS / SYMPTOMS
There are no differentiating signs and symptoms.
INVESTIGATIONS
Normal serum, leukocyte, and whole blood ascorbic acid levels help rule out scurvy.
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