SCURVY (BARLOWS DISEASE)
Vitamin C/ ascorbic acid deficiency.

Rare in western world nowadays. In rest of the world (half of which is India..!), mostly seen in infants - especially those fed exclusively on pasteurized milk.

It takes at least 4months of Vit C deficiency for symptoms and skeletal changes to appear.

The epicentre of pathology in Vit C deficiency is \'capillary fragility\' - leading to tendency towards spontaneous hemorrhage. This is because Vit c is required for formation of connective tissue. (esp collagen and osteoid).
 

Hence, cutaneous petechiae, bleeding gums, malena , hematuria, bone and joints pains (due to subperiosteal h\'ges)

(bleeding gums in the pt)


Lab Ix - S.Ascorbic acid levels would be below 0.6mg/100mL.

Radiological changes are best seen at \'growing ends\' of long bones, esp lower limbs.

1.Generalised osteopenia. (thinning of cortex and loss of trabecular definition)

2.Dense zone of provisional calcification (white line of frenkel).- due to delayed conversion into bone.

 

3.Scorbutic zone (Trummerfield zone) - radiolucent band beneath the prov. zone of calcification.

 

4.Pelken\'s spur - bony protureberences at metaphseal margins.

 

5.Ring epiphysis (Wimbergers sign)

 

6.Subperiosteal hemorrhages.