A 6-year-old child from a low-income household presents with bilateral painful swelling of the wrists, tender subperiosteal hemorrhages over the tibia, perifollicular hemorrhages on the skin, and bleeding gums with loose teeth. The diagnosis and deficient vitamin is:

• A Scurvy — Vitamin C deficiency ✓
• B Rickets — Vitamin D deficiency
• C Pellagra — Niacin (Vitamin B3) deficiency
• D Beri-beri — Thiamine (Vitamin B1) deficiency

Explanation

Scurvy results from vitamin C (ascorbic acid) deficiency, which impairs collagen hydroxylation (prolyl and lysyl hydroxylase require ascorbic acid as a cofactor). Defective collagen leads to subperiosteal hemorrhages, perifollicular hemorrhages, gum hemorrhages with loose teeth (scorbutic gums), and the characteristic 'Frankel's line' and 'Trümmerfeld zone' on X-ray. The 'scorbutic rosary' (from costochondral junction changes) distinguishes scurvy from rachitic rosary. Treatment is vitamin C supplementation 100–200 mg/day.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.