Scurvy: A Forgotten but Timeless Diagnosis—The Diagnostic Value of Radiological Assessment

Background: Scurvy is caused by an inadequate intake of ascorbic acid (Vitamin C). Its incidence seems to be increasing among the pediatric population, even in high-income countries, especially in children with selective eating behaviors. Clinical and laboratory presentations are often nonspecific and may mimic other conditions, making diagnosis challenging and frequently requiring extensive investigations that can delay it. Methods: In this case series, we present four pediatric cases of scurvy observed at the S. Orsola Hospital in Bologna, Italy, over the last 10 years. Results: In all four patients, radiological imaging helped guide the diagnostic work-up by demonstrating skeletal involvement. In three patients, radiological findings were available before treatment and, together with the clinical picture, supported starting vitamin C supplementation before laboratory results were available. In one patient, imaging was performed after treatment had begun and provided additional diagnostic support. Conclusions: Plasma vitamin C measurement remains the laboratory gold standard, but technical challenges and long turnaround times limit its use. Early recognition and treatment are important to interrupt symptoms. This case series underlines the need to keep clinical awareness of scurvy in children with unexplained musculoskeletal symptoms, especially among at-risk populations. Careful clinical evaluation, a comprehensive dietary history, and imaging studies provide a valuable approach to initiating timely therapy.