Medical Assessment and Management
Diagnosis: Scurvy (Vitamin C Deficiency)
This 2-year-old female presents with a classic triad of scurvy: gingival bleeding, perinasal ulcerative lesions, and preceding fever, requiring immediate vitamin C supplementation. 1, 2
Clinical Reasoning
The presentation is highly characteristic of scurvy based on:
- Mucosal bleeding (gingival hemorrhage) occurring 2 weeks ago 1, 2
- Perinasal ulcerative patches consistent with perifollicular hemorrhage and poor wound healing 1, 3
- Preceding fever 2 weeks prior, which may represent concurrent infection or inflammatory response to vitamin C deficiency 1
- Age group at risk - young children with dietary inadequacy are vulnerable to rapid vitamin C depletion (stores last only 1-3 months) 1, 2
The combination of mucocutaneous bleeding, skin lesions near the nose, and gingival involvement strongly suggests scurvy rather than infectious rhinosinusitis, which would present with nasal congestion, purulent discharge, and facial pain/pressure 4, 5. The absence of nasal obstruction, purulent discharge, or respiratory symptoms makes bacterial or viral rhinosinusitis unlikely 5, 6.
Treatment Plan
Medication (Within PhilHealth Konsulta Budget)
Ascorbic Acid (Vitamin C)
- Dosage: 100-300 mg orally once daily 1, 7
- Dispense: 30 tablets
- Duration: 1 month (with clinical improvement expected within 1-2 weeks) 1, 7
- Cost: Approximately 50-100 pesos (well within 300 peso limit)
Topical Wound Care
Petroleum jelly or plain emollient cream
- Apply to perinasal lesions twice daily
- Dispense: 1 small tube (10-15g)
- Duration: Until lesions heal (typically 2 weeks)
- Cost: Approximately 30-50 pesos
Total medication cost: 80-150 pesos
Follow-up Instructions
- Return in 1 week to assess clinical improvement 1, 7
- Expect resolution of gingival bleeding within 7-10 days 1, 7
- Skin lesions should begin healing within 2 weeks 1
- Dietary counseling: Increase intake of vitamin C-rich foods (citrus fruits, guava, papaya, malunggay) 2
Medical Certificate
This certifies that the patient has been seen and examined today with the diagnosis of: Scurvy (Vitamin C Deficiency) with gingival bleeding and perinasal skin lesions
Recommendation: Vitamin C supplementation 100-300 mg daily for 1 month, topical wound care, dietary modification with vitamin C-rich foods, follow-up in 1 week. Patient is fit to return to school after 3-5 days once gingival bleeding has stopped and skin lesions show improvement.
This medical certificate is issued upon the request of the patient for: Return to school after medical leave due to illness.
Critical Clinical Pearls
- Scurvy can develop rapidly in children (within 1-3 months of inadequate vitamin C intake) 1, 2
- Gingival bleeding and perifollicular hemorrhage are pathognomonic findings 1, 2
- Laboratory confirmation of vitamin C levels is not necessary when clinical presentation is classic 1
- Clinical improvement is rapid and dramatic with supplementation, confirming the diagnosis 1, 7
- Investigate underlying dietary inadequacy or malabsorption if symptoms recur 8