Scurvy with Musculoskeletal Pain in Indonesian Pediatric Patient: A Case Report
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Pediatric Sub-Division, Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia 2Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia, Indonesia 
Background: Scurvy is a potentially fatal disease caused by a severe deficiency of vitamin C, which can manifest as a musculoskeletal problem. Early diagnosis and treatment of vitamin C deficiency are crucial to prevent severe symptoms. Unfortunately, vitamin C level evaluations in Indonesia are very limited due to the lack of laboratory facilities. As a result, patients with scurvy are often underdiagnosed and do not receive adequate management. Case Presentation: 5-year-old boy with musculoskeletal pain and inability to walk. Radiographic findings showed a pathognomonic line of Fränkel, Trümmerfeld zone, and Wimberger ring sign, with laboratory evaluation showing an anemia and vitamin D deficiency. We did not perform a laboratory examination for vitamin C due to a lack of test facilities but the patient was given oral 250 mg of vitamin C daily instead. The patient showed significant improvement in symptoms and laboratory results after three months of vitamin C supplementation. To summarize, that vitamin C deficiency should be considered among patients with related musculoskeletal manifestations supported by imaging results.
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