Medical Mystery Solved - A Deficient Diagnosis | NEJM 

I am for India. Fortunately or unfortunately 40-50 seconds in history i suspected scurvy.. It can be a tricky diagnosis.. There is so much pain due to bone changes, that sometimes kids present with pseudo-paralysis. A very good and needed video specially who work in high end hospitals. It is also common in Cancer patients

The "picky eating" had me thinking what it could be...and i was surprised to see that it was scurvy. A thorough Anamnesis can go a long way, but understandable, since nowadays everything is fast...Amazing case! Thanks!

Before going through all those invasive procedure, a simple nutritional assessment would have done it. I think more than the diagnosis, the important takeaway for video is to have in depth, detailed history to exclude all possible differentials. Very much grateful for this wonderful presentation 🙏🙏

American way of diagnosis 😂

Scurvy must definitely be considered as a differential diagnosis of musculoskeletal symptoms in children with developmental needs. Especially if the child has picky eating, where child avoids fruits and vegetables

Nice OSCE-like demonstration for everyone to brainstorm

I love my teacher ...dr.Bhose ❤

To me the possibility of scurvy felt possible from the very beginning. I and many other people with ASD were far too close to being in the same position

Detailed dietry history will be beneficial in children

No offense but those were highly invasive procedures, and took way too long to come to that diagnosis. I don't see this as a win for medicine. Then again, a good reminder on what the child's diet consisted of was missed during the case history. A simple mistake.

Very interesting case. Thanks!

Thank you for reminding , nutritional deficiencies are very common in new generation, maybe attributable to altered dietary habits .

Very interesting case- thank you so much for highlighting the occurrence of Vit C deficiency even in resource rich settings. However, scurvy should have been in the differential from the beginning and an empiric trial of vitamin C would have spared this child from going through so many expensive and painful investigations. With the advent of iOmics and precision medicine , treatment for even common conditions is likely to get extremely expensive. Maybe case discussions in the future should also pause after H&P, and brainstorm possible treatment options if you had nothing further to go upon- ie. no further information from expensive investigations

🎯 Key Takeaways for quick navigation: 00:07 🚑 *Presentación del caso y síntomas iniciales* - Niño sano de dos años y medio con dificultad para cargar peso en la pierna derecha. - Radiografía muestra posible fractura de peroné, preocupación por causas infecciosas, malignas, inflamatorias o neuromusculares. - Desarrollo posterior de dolor en la pierna izquierda y síntomas gingivales, aumentando la preocupación por leucemia. 01:33 🏥 *Evaluación en el departamento de emergencias* - Agitación y dolor en ambas piernas, sospecha de trauma no accidental. - Pruebas muestran bajo nivel de hemoglobina, tamaño reducido de glóbulos rojos, y posible leucemia. - Consideración de anemia por deficiencia de hierro o envenenamiento por plomo. 02:57 🧠 *Evaluación neurológica y complicaciones* - Realización de resonancia magnética de cabeza y columna, descartando Guillain-Barré. - Desarrollo de erupción cutánea y traslado a otro hospital para evaluación adicional. - Exploración de posibles causas de parálisis en las extremidades inferiores, incluyendo la posibilidad de una picadura de garrapata. 04:23 🩹 *Exploración de otras posibles causas* - Estudios serológicos para condiciones reumatológicas y deficiencias nutricionales. - Resultados normales en pruebas de inflamación muscular y niveles de vitaminas. - Reevaluación de radiografías y CT scans revela bandas metafisarias lucentes en el fémur. 05:46 🍊 *Diagnóstico final y tratamiento* - Diagnóstico de escorbuto por deficiencia de vitamina C. - Inicio de suplementos de ácido ascórbico, mejoría en una semana. - Importancia de la historia dietética detallada para un diagnóstico preciso. Made with HARPA AI

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D/ Vit C Defiance