X ray findings reveal Scurvy in 2 year old: A case study

There was no prior diagnosis of developmental delay was reported in the case. But due to concern for neglect, a skeletal survey was ordered.

The following findings were seen on the x-ray of the girl's distal femur and proximal tibia:

• Frankel lines: Dense zones of provisional calcification
• Pelkan spurs: Bony spurring at the periphery of the zone of metaphyseal calcification
• Trümmerfeld zone: Lucent bands in the metaphysis below the Frankel line

X-ray of the patient's left knee showed dense zones of provisional calcification (F: Fraenkel line) with underlying lucent metaphyseal bands (T: Trummerfeld zone). In addition spurring at the distal femur and proximal tibia (P: Pelkan spurs) and a displaced fracture of distal femoral metaphysis was also identified. 

Although the clinical and radiographic characteristics of scurvy were well defined but the the diagnosis was clinched by most reliable test- the girl's vitamin C level.

The authors reported that the patient rapidly improved after receiving vitamin C supplements, which retrospectively confirmed the diagnosis.

 Case study Reference:

A 2-year-old with Scurvy: A Modern case of a historical disease by Wiese M et. al published in the Visual Journal of Emergency Medicine.

https://doi.org/10.1016/j.visj.2021.101122