(A949) Scurvy After Surgery: A Rare Cause of Delayed Bleeding in Pediatric Adenotonsillectomy

Introduction: Scurvy is a clinical condition caused by severe vitamin C deficiency with distinctive dermatologic, gingival, orthopedic, and wound healing findings. Historically, this condition was associated with long sea voyages and poor nutrition. Although still rare in children, recent studies have demonstrated a threefold increase in incidence and an association with male sex, low income, obesity and autism spectrum disorder.

Methods: We conducted a review of the literature regarding scurvy in otolaryngology and present a case involving hemorrhage, impaired wound healing, and a delayed diagnosis following adenotonsillectomy.

Results: A 4-year-old male with a prior diagnosis of autism and a restrictive diet underwent an adenotonsillectomy in July 2024 to address sleep-disordered breathing. His initial recovery was uncomplicated. Six weeks postoperatively, he presented with significant positional epistaxis and bloody otorrhea originating from previously placed pressure equalization tubes. The otorrhea was only partially manageable in the clinic, leading to further evaluation in the operating room. Microscopic ear evaluation showed clot but no active bleeding. Examination of the adenoid pad and tonsillar fossa demonstrated clot and active bleeding consistent with immediate post-surgical findings. Bleeding was controlled with electrocautery and he was discharged without issue.
Three weeks later, he was readmitted due to progressive changes in gait, characterized by waddling, and an acute inability to bear weight. A diagnosis of scurvy was established based on clinical findings. Following one week of high-dose vitamin C supplementation, his symptoms improved, with a return of normal gait and healthier appearance of his hair and gums.

Conclusions: With the incidence of scurvy on the rise, otolaryngologists should be aware of the presentation and risk factors associated with this rare condition. Scurvy should be considered in cases of delayed wound healing or regression, especially in children with food insecurity, restrictive diet, or autism spectrum disorder.