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Debortoli C, Catherine JH, Falguiere A, Lan R, Campana F. Mysterious oral manifestations in a 6-year-old child. Oral Dis 2024; 30:4063-4065. [PMID: 38071457 DOI: 10.1111/odi.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 10/08/2024]
Affiliation(s)
- Cyril Debortoli
- DDS, Aix Marseille University, APHM, La Timone, Oral surgery Department, Marseille, France
| | - Jean-Hugues Catherine
- DDS, Aix Marseille University, APHM, La Timone, Oral surgery Department, Marseille, France
| | - Arthur Falguiere
- DDS, Aix Marseille University, APHM, La Timone, Oral surgery Department, Marseille, France
| | - Romain Lan
- DDS, Aix Marseille University, APHM, La Timone, Oral surgery Department, Marseille, France
| | - Fabrice Campana
- DDS, Aix Marseille University, APHM, La Timone, Oral surgery Department, Marseille, France
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Küçükalİ B, Bayrak H, Yıldırım DG, İnci A, Bakkaloğlu SA, Tümer L. A 7-year-old boy with scurvy owing to coeliac disease. Paediatr Int Child Health 2024; 44:63-67. [PMID: 38695492 DOI: 10.1080/20469047.2024.2347001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/20/2024] [Indexed: 08/13/2024]
Abstract
ABBREVIATIONS ESR: erythrocyte sedimentation rate; Hb: haemoglobin; HSP: Henoch-Schönlein purpura; WCC: white-cell count.
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Affiliation(s)
- Batuhan Küçükalİ
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Harun Bayrak
- Department of Paediatric Metabolic Disorders, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Gezgin Yıldırım
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aslı İnci
- Department of Paediatric Metabolic Disorders, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Leyla Tümer
- Department of Paediatric Metabolic Disorders, Gazi University Faculty of Medicine, Ankara, Turkey
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Cabaleiro-Raña N, Santos-Álvarez D, Romar de Las Heras L, Álvarez-Reguera C, Cervantes Pérez EC, Hernández Cancela RM, Romero-Yuste S. Scurvy. A forgotten pseudovasculitis. REUMATOLOGIA CLINICA 2024; 20:281-285. [PMID: 38821739 DOI: 10.1016/j.reumae.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/18/2024] [Indexed: 06/02/2024]
Abstract
Scurvy is a nutritional disease caused by ascorbic acid (vitamin C) deficiency. Althought currently it is a rare disease, we should considerer it in the differential diagnosis of purpura and arthritis in patients with restrictive diets. We present the case of a 49-year-old man with a history of a nutritional disorder presented to our hospital with generalized purpura and hemarthros. Following the anamnesis and laboratory findings, rheumatological, infectious and hematological etiologies were excluded. Finally, the diagnosis of scurvy was made upon demostration poor levels of vitamin C and a spectacular response to nutritional supplements. We compare this case with 19 similar cases reported in the medical literature.
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Affiliation(s)
- Noelia Cabaleiro-Raña
- Servicio de Reumatología, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
| | - Diego Santos-Álvarez
- Servicio de Reumatología, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Carmen Álvarez-Reguera
- Servicio de Reumatología, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | - Susana Romero-Yuste
- Servicio de Reumatología, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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Gaieski DF. Scurvy: A Rare Disease or a Rare Diagnosis? J Emerg Trauma Shock 2024; 17:53-57. [PMID: 39070860 PMCID: PMC11279507 DOI: 10.4103/jets.jets_108_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 07/30/2024] Open
Abstract
Introduction Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness's sake. Methods We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the mid-Eastern United States. Presenting signs and symptoms, known scurvy risk factors, Vitamin C levels, clinical course, and outcome for each patient are described. Results There were 14 presentations by 12 patients diagnosed with scurvy who were initially evaluated in the ED between 1993 and 2023. Each patient had a known risk factor for inadequate Vitamin C intake. All had clinical findings suggestive of scurvy and all but one had a subnormal serum Vitamin C level detected on serum samples sent from the ED. Conclusion The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies.
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Affiliation(s)
- David F. Gaieski
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Grecia FR, Barrera-Godínez A, Gatica-Torres M, López-López K, Bermudez-Rodríguez SP, Domínguez-Cherit J. Scurvy: a forgotten but still present disease. Int J Dermatol 2023; 62:1307-1309. [PMID: 37356049 DOI: 10.1111/ijd.16775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/12/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Figueroa-Ramos Grecia
- Department of Dermatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Alejandro Barrera-Godínez
- Department of Dermatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Michelle Gatica-Torres
- Department of Dermatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Karla López-López
- Department of Dermatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Judith Domínguez-Cherit
- Department of Dermatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Robin CJ, Robin KJ, Maier MA, Stevens ES. A Rare Presentation of Scurvy in a Well-Nourished Patient. Cureus 2023; 15:e46379. [PMID: 37927702 PMCID: PMC10620061 DOI: 10.7759/cureus.46379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Vitamin C deficiency, otherwise known as scurvy, is a rare diagnosis among populations with adequate nutritional resources. We present a 37-year-old female patient with bilateral lower extremity edema, episodic anasarca, petechiae, and easy bruising who was diagnosed with scurvy. Given the clinical presentation, a broad differential was investigated with no findings suggestive of hematologic or cardiovascular pathology. Initial laboratory studies were unremarkable. Progression of cutaneous symptoms and subsequent laboratory findings demonstrating low vitamin C levels supported a diagnosis of scurvy. Classical symptoms of scurvy include mucocutaneous petechiae, poor wound healing, ecchymosis, hyperkeratosis, corkscrew hair, gingival swelling, and bleeding gums. Following standard enteral supplementation of vitamin C, repeat vitamin C levels failed to adequately respond with the patient remaining to be symptomatic. Given a lack of insufficient nutritional intake or known systemic illness, gastrointestinal malabsorptive etiology was suspected. Though rare in the United States, scurvy should be considered in patients with manifestations of a bleeding disorder. A gastrointestinal workup may be indicated if other nutritional deficiencies are identified, or a source of inadequate intake cannot be established.
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Affiliation(s)
- Connor J Robin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Kaleb J Robin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Mark A Maier
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Elyse S Stevens
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
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Newsom NR, Kara A, Ladd L. Musculocutaneous manifestations of scurvy. BMJ Case Rep 2023; 16:e253648. [PMID: 37567736 PMCID: PMC10423777 DOI: 10.1136/bcr-2022-253648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Nicholas Ryan Newsom
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Areeba Kara
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lauren Ladd
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Shaw D, Fozdar S, Owen C. Purpuric rash on the lower legs. BMJ 2023; 381:e075249. [PMID: 37348904 DOI: 10.1136/bmj-2023-075249.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Daniel Shaw
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Siddiq Fozdar
- Haslingden Healthcare, Haslingden, Rossendale, Lancashire, UK
| | - Caroline Owen
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
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Bertrand V, Millardet E, Bouchereau J, Dhenin C, Bruel H. Suspicion of Munchausen syndrome by proxy with a child's presentation of undernutrition, scurvy, and an apparent Avoidant Restrictive Food Intake Disorder. Eat Weight Disord 2022; 27:3815-3820. [PMID: 36565378 DOI: 10.1007/s40519-022-01520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Avoidant Restrictive Food Intake Disorder (ARFID) was recently characterized in the DSM-5 classification. Potential differential diagnoses remain poorly reported in the literature. Our purpose was to present a possible Munchausen syndrome by proxy with undernutrition and scurvy, presenting as ARFID in a child. METHODS We describe here a case of an 8-year-old boy who presented with severe undernutrition (BMI = 11.4) and scurvy leading to joint pains. The boy had had a very selective diet since early childhood, and his condition required hospitalization and enteral refeeding. Because of his specific eating behaviour, an ARFID was initially suspected. However, observation of the mother-child relationship, analysis of the child's eating behaviour, and retrospective analysis of his personal history suggested that this was not a true ARFID, and that the selective eating behaviour had probably been induced by the mother over many years, who probably maintained a low variety diet. CONCLUSION Munchausen syndrome by proxy is a difficult differential diagnosis, which may also affect patients with ARFID symptoms, which may also present in the affected child as apparent ARFID. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Valérie Bertrand
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France.
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.
| | - Ekatarina Millardet
- Child Radiology Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
| | - Juliette Bouchereau
- Reference Center for Inborn Error of Metabolism, Department of Paediatrics, Necker Hospital, Assistance Publique-Hôpitaux de Paris, G2M Network, MetabERN, Paris, France
| | - Caroline Dhenin
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
| | - Henri Bruel
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
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Muacevic A, Adler JR, Turney K, Driscoll M. Scurvy: A Diagnosis Not to Be Missed. Cureus 2022; 14:e33050. [PMID: 36721542 PMCID: PMC9881687 DOI: 10.7759/cureus.33050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Vitamin C deficiency, one of the oldest-known nutritional disorders, is now uncommon in high-income countries. Recently, however, there has been an increase in cases of vitamin C deficiency, also known as scurvy. We report three adult patients with histories of homelessness, food insecurity, and poor nutrition, making them particularly vulnerable to restrictive diets and at increased risk for scurvy. After proper diagnosis and treatment, favorable outcomes can be rapidly obtained. This case series emphasizes the importance of keeping a broad differential diagnosis and inquiring about nutritional history in patients presenting with purpura, gingival bleeding, and body hair changes.
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MnO2 nanosheet-assisted ratiometric fluorescent sensor for ascorbic acid based on Pyronin Y and thiamine. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Essien F, Jacocks C, Carroll M. Sailing the ship of life: scurvy and autoimmunity . . .. Ther Adv Chronic Dis 2022; 13:20406223221078080. [PMID: 35386121 PMCID: PMC8977701 DOI: 10.1177/20406223221078080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 12/27/2022] Open
Abstract
Celiac disease (CD) is a multisystem disorder known to manifest in a multitude of ways to
include diarrhea, anemia, and nutritional deficiencies. The malabsorptive state can
present as certain classical conditions such as autoimmune gastritis and
osteopenia/osteoporosis but scurvy is less recognized within the literature. In this case,
we present a unique presentation of scurvy as a result of an undiagnosed CD.
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Affiliation(s)
- Francis Essien
- Department of Internal Medicine, David Grant Medical Center, Travis Air Force Base, 101 Bodin Circle, Fairfield, CA 94533, USA
| | - Charles Jacocks
- Department of Internal Medicine, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA
| | - Matthew Carroll
- Department of Rheumatology, Singing River Health System, Ocean Springs, MS, USA
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