Orbital hemorrhage secondary to ascorbic acid deficiency (scurvy) in a 5-year-old boy
Nov 20, 2017
A 5-year-old African American boy presented at Nicklaus Children’s Hospital, South Miami, with a 2-week history of right superior eyelid ecchymosis A, slight proptosis of the right eye, gingival bleeding B, and right-sided limp. His medical history was notable for autism. Labora-tory work-up was initiated for neuroblastoma as well as leukemia and blood dycrasias. Magnetic resonance imaging of the brain and orbits revealed a 1.5 × 1.3 × 2.4 cm mass in the right superol-ateral extraconal space with mass effect upon the lateral rectus and superior muscle group. The mass demonstrated T1-weighted intermediate-to-high signal plus rim enhancement C and T2-weighted hyperintensity D. The lesion abutted the right lacrimal gland, which was displaced anteriorly. Although less likely, the differential diagnosis of rhabdomyosarcoma and Langer-han’s histiocytosis were also entertained, and, given the suspicion for malignancy, a bone marrow biopsy was ordered, which revealed normal cellularity. The patient was scheduled to undergo an orbital biopsy, before which other causes of abnormal bleeding were explored. Vitamin C levels proved to be extremely low 0.13 mg/dl indicating scurvy-associated findings, and the patient was supplemented with oral ascorbic acid 250 mg four times daily. With vitamin supplementation and nutritional rehabilitation his symptoms resolved over the subsequent weeks.