Scurvy: A disease almost forgotten

Department of Dermatology, Division of Regional and International Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA.
International Journal of Dermatology (Impact Factor: 1.31). 09/2006; 45(8):909-13. DOI: 10.1111/j.1365-4632.2006.02844.x
Source: PubMed


Although much decreased in prevalence, scurvy still exists in industrialized societies. Few recent large studies have examined its pathogenesis, signs, and symptoms.
After we diagnosed scurvy in a 77-year-old female patient in 2003, we conducted a retrospective records review to identify patients with scurvy treated between 1976 and 2002 at Mayo Clinic (Scottsdale, Arizona; Rochester, Minnesota; or Jacksonville, Florida). We also searched the English-language medical literature for published reports on scurvy.
In addition to our patient, seven of 11 patients whose records in the institutional database mentioned vitamin C deficiency were women. The age ranged from a neonate to 77 years (mean, 48 years). The most common associated causes were concomitant gastrointestinal disease, poor dentition, food faddism, and alcoholism. Vitamin or mineral deficiencies other than vitamin C deficiency were also found in our patients who had scurvy. The most common symptoms were bruising, arthralgias, or joint swelling. The most common signs were pedal edema, bruising, or mucosal changes. Four patients had vague symptoms of myalgias and fatigue without classic findings, and five had concomitant nutritional deficiencies. Follow-up available for six of 12 patients treated by vitamin C supplementation showed complete resolution of symptoms in five.
Patients with scurvy may present with classic symptoms and signs or with nonspecific clinical symptoms and an absence of diagnostically suggestive physical findings. Concomitant deficiency states occur not uncommonly. Taking a thorough dietary history and measuring serum ascorbic acid levels should be considered for patients with classic signs and symptoms, nonspecific musculoskeletal complaints, or other vitamin or mineral deficiencies.

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    • "Ascorbate (vitamin C) is a cofactor for prolyl and lysyl hydroxylases in collagen synthesis and crosslinking. Therefore, clinical manifestations are due to defective collagen in the dermis, blood vessels, and surrounding connective tissue[124,144]. Typically, follicular hyperkeratosis with enlarged, broken, corkscrew hairs growing out of erythematous follicles is the most distinctive finding of scurvy. "
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    • "2009). Without sufficient amounts of vitamin C in the diet, ascorbic acid levels will steadily decrease, and if stores drop below 350 mg, scurvy develops (Olmedo et al., 2006; Popovich et al., 2009). Common symptoms of scurvy include petechiae (small red spots reflecting subcutaneous bleeding produced from ruptured blood vessels) in the trunk and limbs, bruising, inflamed and bleeding gums, generalized bleeding (gastrointestinal, gynecological, cerebral, and large postcranial subperiosteal hemorrhage), fatigue, weakness, weight loss, irritability, and depression (Fain, 2005; Popovich et al., 2009; Russell, 2005). "
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    ABSTRACT: This paper presents the first bioarchaeological evidence of probable scurvy in Southeast Asia from a six-year-old child at the historic-era site of Phnom Khnang Peung (15–17th centuries A.D.) in the Cardamom Mountains, Cambodia. Examination of skeletal material shows evidence consistent with scurvy – specifically, abnormal porosity on the greater wings of the sphenoid bone and hard palate, and vascular impressions on the ectocranial surface of the frontal bone and maxillary alveolar bone. In addition, this individual has evidence of cribra orbitalia indicative of anemia. Although a nutritionally linked etiology is the most common cause of scurvy, a number of other factors influencing ascorbic acid levels need to be considered in an environment with sufficient vitamin C potentially available in the diet. Assessing the environmental evidence, the possibility of a number of interrelated factors contributing to the development of scurvy in this individual seems the most plausible explanation. Factors affecting vitamin C levels may have included social aspects of food allocation or choice of food, genetic predisposition, anemia, pathogens, and nutrient malabsorption.
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    • "It has a biological half-life of approximately 30 minutes. Humans are unable to synthesize ascorbic acid and therefore require an exogenous source for daily metabolic requirements.6 The daily requirement is obtained from natural sources such as citrus fruits and vegetables. "
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    ABSTRACT: Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.
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