**5. Discussion**

Main findings encountered in our case report, in fact, meet with the manifestations most commonly reported in the literature. Hahn et al. described the data obtained from 77 patients but did not mention any oral manifestation [12]. A recent literature review by Kothari et al. yielded 77 cases and gingival swelling, pain and bleeding were noted in all but three of the cases in which intraoral findings were described [23]. A review by Ratanachu-Ek et al. reported 86% of pediatric scurvy cases were initially misdiagnosed; a correct diagnostic approach should be based on the recognition of clinical manifestations [24]. Oral soft tissue involvement was the most striking sign that we observed in our patient, and it was also described in 92 out of the 107 selected studies (83.7% of examined patients). This important observation is the reason why clinicians that treat children and pediatric dentists should consider atypical gingival swelling or other gingival manifestations as one of the early signs of scurvy [25]. Scurvy is rare, but it still occurs among children with autism and developmental disorders, so this condition should be kept in mind in a clinical constellation of gingival involvement, lower extremity pain, limp, non-blanching rash, fatigue, anemia, in particular in children with an history of selective diet [26]. Having a comprehensive dietary history as part of the data gathering is fundamental to the early recognition of nutritional deficiency diseases in order to avoid invasive procedures and/or their severe complications [27].
