When a previously healthy 7-year-old girl limped into the emergency department with unexplained leg pain, a detailed dietary history became critical to diagnosing and ultimately treating her.
She'd had pain in both her legs and a limp for over 6 weeks. She had not fallen, had no direct trauma, and was not involved in any high-impact activities, reported Emanuele Savasta, MD, of the Regina Margherita Children's Hospital at the University of Turin in Italy, and co-authors in NEJM Evidence.
She was in the 50th percentile for both weight and height, had normal neurological development, and the rest of her body felt fine.
While the team initially formed a broad differential diagnosis, the breakthrough came when they asked about her diet, co-author Franca Fagioli, MD, also of the Regina Margherita Children's Hospital, told MedPage Today.
They learned that she subsisted on mostly dairy and refined carbohydrates, ate very few fruits and vegetables, and largely avoided fruit juice and vitamin supplements, which raised concern for potential vitamin C deficiency.
