Scurvy Due to Malnutrition in Autistic Spectrum Disorder

A 7-year-old boy was presented by his mother for an assessment of dental status due to his refusal to eat and recurrent oral bleeding. Highly selective eating behavior is typical of autistic spectrum disorder. The boy predominantly subsisted on potato chips and sweet drinks. Over the previous 6 weeks, his general condition had deteriorated and he had lost 5% of his body weight and experienced leg pain, leading to his refusal to walk. A physical examination was possible to only a limited extent due to the patient’s lack of cooperation. However, ecchymosis was found on the lower extremities (Figure). Due to poor compliance, a dental assessment was only possible under general anesthesia. This revealed marked gingival hyperplasia and an increased tendency to bleed, but no evidence of a dental cause. Laboratory analysis of ascorbic acid in serum showed a very low level (0.5 mg/l; normal range, 4.6–14.9 mg/l) and confirmed the suspected diagnosis of scurvy due to severe vitamin C deficiency. With oral supplementation of vitamin C, the patient’s symptoms improved within a matter of weeks.

Figure

Dr. med. Matthias Posch, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg, [e-mail]

Anna Erbis, Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Freiburg

Dr. med. Henrike Pommerening, Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, Universitäts-Herzzentrum Freiburg

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Posch M, Erbis A, Pommerening H: Scurvy due to malnutrition in autistic spectrum disorder. Dtsch Arztebl Int 2025; 122: 234. DOI: 10.3238/arztebl.m2025.0033