Table 3 Timeline of medical history and interventions

T = 0 (20 Jul–2 Aug)

Physical examination: severe pallor, petechial hemorrhages on arms and legs, gum hypertrophy and bleeding, macroscopic hematochezia, and, finally, tachycardia and dyspnea. No evidence of hepatosplenomegaly or lymphadenopathies or joint effusions

Leg X-ray (21 Jul): dense lines at the distal right femoral metaphysis and a lucent metaphyseal band

Laboratory tests (22–24 Jul): severe anemia, low levels of iron, ferritin, ascorbic acid, 25-OH-vitamin D, and 1,25-OH-vitamin D

Vitamin C supplementation was practiced, starting from 300 mg/day for 28 days, followed by 100 mg/day in maintaining phase.

Introduction of fruit and vegetables in the child’s diet

T = 3 months

(3 Nov)

Physical examination:

good clinical state. No cutaneous or mucosal alterations. Resolution of limping

Laboratory tests: normal value of hemoglobin (12.6 g/dl) and ascorbic acid (59 μmol/L)

Leg X-ray: no radiological anomalies

Suspension of any treatment