1
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Malani KA, O'Brien J. Vitamin C Deficiency as a Mimicker of a Coagulation Disorder. BMJ Case Rep 2024; 17:e259310. [PMID: 38417944 PMCID: PMC10900373 DOI: 10.1136/bcr-2023-259310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Scurvy is caused by vitamin C deficiency and is often thought of as an ancient malady. However, it still afflicts present-day patients with insufficient nutrition, excessive alcohol consumption and disorders of absorption. Scurvy is traditionally characterised by ecchymosis, petechiae, haemorrhages, poor wound healing, myalgias and arthralgias, but it can also present with non-specific symptoms, including mood changes, fatigue, malaise and dyspnoea. Although scurvy can present with signs of excess bleeding, it does not involve blood clotting. We present a case of concurrent scurvy and pulmonary embolism in which clinical presentation and laboratory findings mimicked a coagulation disorder, resulting in delayed diagnosis and excessive resource expenditure. This case underscores the importance of obtaining an early dietary and substance use history in patients with unexplained haematological symptoms. These crucial components of history-taking can significantly reduce invasive and costly tests, resulting in quicker diagnosis and enhanced patient outcomes.
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Affiliation(s)
- Kanika Ajay Malani
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jill O'Brien
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Medicine, Miriam Hospital, Providence, RI, USA
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2
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Falkenberg AL, Karkenny AJ, Sharkey MS. Orthopaedic Manifestations of Scurvy in an Otherwise Healthy Child from a Low Opportunity Index Neighborhood: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00037. [PMID: 38422190 DOI: 10.2106/jbjs.cc.23.00671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
CASE A 23-month-old otherwise healthy female child from a low opportunity index neighborhood presented with 1 month of lower extremity pain and refusal to bear weight. Radiographic evaluation of bilateral knees revealed lucent metaphyseal bands and a nondisplaced distal femoral metaphyseal corner fracture. A workup identified vitamin C deficiency (scurvy), and the child's symptoms and radiographic abnormalities resolved with vitamin C supplementation. CONCLUSIONS Scurvy should be considered in children with unexplained musculoskeletal symptoms who may lack access to nutrient-dense foods.
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Affiliation(s)
| | - Alexa J Karkenny
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, New York
| | - Melinda S Sharkey
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, New York
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3
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Hayashino K, Meguri Y, Komura A, Matsubara C, Shiraishi Y, Yoshida C, Yamamoto K, Imajo K. An Unbalanced Diet Limited to the Consumption of Boiled Vegetables Led to the Onset of Scurvy. Intern Med 2022; 61:1795-1798. [PMID: 34776483 PMCID: PMC9259325 DOI: 10.2169/internalmedicine.8122-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Scurvy is a rare disease caused by a vitamin C deficiency. Vitamin C is a water-soluble vitamin found in vegetables and fruits, but it is lost after boiling. A 59-year-old man presented with gingival pain after having a tooth extracted five years previously. Following the procedure, his diet comprised boiled vegetables to prevent pain. He then experienced bilateral lower leg pain, and computed tomography revealed intramuscular bleeding. His serum vitamin C level was below the detectable limit. His symptoms immediately improved with vitamin C administration. This case emphasized that consuming only boiled vegetables can lead to the onset of scurvy.
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Affiliation(s)
| | - Yusuke Meguri
- Department of Hematology, Okayama City Hospital, Japan
| | - Aya Komura
- Department of Hematology, Okayama City Hospital, Japan
| | | | | | | | | | - Kenji Imajo
- Department of Hematology, Okayama City Hospital, Japan
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4
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Subhash S, Santosh ST. Scurvy in Children: The Silent Masquerader. J Trop Pediatr 2022; 68:6563640. [PMID: 35380727 DOI: 10.1093/tropej/fmac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In modern society, scurvy is well known in its historical perspective rather than clinical relevance. Scurvy is classically thought to manifest with signs of 'bleeding painful gums' in the undernourished. Little is known regarding its ability to mimic a wide range of rheumatological, orthopaedic, neurological and haematological illnesses. Due to the rarity of its occurrence, there is a poor understanding among present-day clinicians, and so scurvy can easily deceive the uninitiated. We report a school-aged boy with normal neurodevelopment who presented with lower limb pain and difficulty in walking. He was seen by multiple specialist doctors before the clinical diagnosis of scurvy was made by a general paediatrician. Investigations showed that this child had X-ray changes typical of scurvy with low serum ascorbic acid levels. On supplementation with vitamin C, he showed dramatic improvement in symptoms and gradually achieved complete recovery.
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Affiliation(s)
- Swathy Subhash
- Department of Paediatrics, KIMSHEALTH, Trivandrum, Kerala, India
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5
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Pallant A, Sullivan T, Kaluzny A. Nutritional deficiency presenting as acute pain, fatigue and bruising in a college health clinic. J Am Coll Health 2022; 70:670-672. [PMID: 32432971 DOI: 10.1080/07448481.2020.1767111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
A previously healthy university student presents to Health Services with sudden onset of pain, fatigue, bruising, and a rapidly progressive anemia. There was not any previous significant health history. The case discussion will emphasize the critical overlap of physical and mental health assessments in identifying the cause and cure of a potentially life-threatening health crisis for a young adult student.
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Affiliation(s)
- Adam Pallant
- Health Services, Brown University, Providence, Rhode Island, USA
| | - Tanya Sullivan
- Health Services, Brown University, Providence, Rhode Island, USA
| | - Andrew Kaluzny
- Health Services, Brown University, Providence, Rhode Island, USA
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6
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Fickrey A, Muhd Helmi MA, Azian AA, Shukrimi A, Fadzil A. Vitamin C deficiency in a picky eater child. Med J Malaysia 2021; 76:753-756. [PMID: 34508390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Vitamin C deficiency or scurvy is an uncommon condition that occurs in poorly developed countries or in refugee camps. Nonetheless, in countries where food is readily available, like Malaysia, occasionally there are cases of vitamin C deficiency reported. Although it was primarily reported in children with special needs or learning disability, scurvy is encountered in children with normal development, among the severe picky eaters. We present here case of a nine-year-old picky-eating boy with scurvy. The development of scurvy in this child took several years, especially after he became a very selective eater at the age of five. The child had displayed limping when walking with knee-joint pain before he came to a primary hospital. However, his condition was not diagnosed promptly and progressively worsened until he was unable to walk. Thus, it is crucial to recognize scurvy in children who limps and are severe picky eaters.
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Affiliation(s)
- A Fickrey
- Sultan Ahmad Shah Medical Centre @ IIUM, Department of Pediatrics, Kuantan, Pahang Darul Makmur, Malaysia.
| | - M A Muhd Helmi
- Sultan Ahmad Shah Medical Centre @ IIUM, Department of Pediatrics, Kuantan, Pahang Darul Makmur, Malaysia
| | - A A Azian
- Sultan Ahmad Shah Medical Centre @ IIUM, Department of Radiology, Kuantan, Pahang Darul Makmur, Malaysia
| | - A Shukrimi
- Sultan Ahmad Shah Medical Centre @ IIUM, Department of Orthopedics, Kuantan, Pahang Darul Makmur, Malaysia
| | - A Fadzil
- Sultan Ahmad Shah Medical Centre @ IIUM, Department of Pediatrics, Kuantan, Pahang Darul Makmur, Malaysia
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7
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Abstract
ABSTRACT Ketogenic diets used for treating various neurological disorders can have potentially serious adverse effects. Among these is scurvy, a rarely reported, yet potentially fatal adverse effect of the ketogenic diet caused by vitamin C deficiency. We report a case of a 5-year-old patient with autism, who presented with scurvy secondary to the dietary restrictions of a ketogenic diet. Our review of the literature showed a single previously reported case of vitamin C deficiency in a patient on ketogenic diet. We have also reviewed the clinical indications and adverse effects of ketogenic diets with special reference to scurvy. This case emphasizes the importance of vitamin supplements in patients consuming a special diet.
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Affiliation(s)
- Syed Amir Ahmad
- From the Department of Emergency Medicine (Pediatric Unit), College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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8
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Affiliation(s)
- Malan Kern
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jerad M Gardner
- University of Arkansas for Medical Sciences, Little Rock, AR
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9
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Bhattacharyya P, Giannoutsos J, Eslick GD, Fuller SJ. Scurvy: An Unrecognized and Emerging Public Health Issue in Developed Economies. Mayo Clin Proc 2019; 94:2594-2597. [PMID: 31806112 DOI: 10.1016/j.mayocp.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Puja Bhattacharyya
- Department of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Nepean Hospital, Kingswood, Australia
| | - John Giannoutsos
- Department of Medicine, Faculty of Medicine and Health, The University of Sydney, Nepean Hospital, Kingswood, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, The University of Sydney, Penrith, New South Wales, Australia
| | - Stephen J Fuller
- Department of Medicine, Faculty of Medicine and Health, The University of Sydney, Nepean Hospital, Kingswood, Australia
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Schlomer T, Di Lucca J, Bart PA. [Cutaneous manifestations of nutritional deficiencies]. Rev Med Suisse 2019; 15:2125-2130. [PMID: 31746568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In elderly or chronically ill patients, nutritional deficiencies are common and the presence of related skin lesions is not unusual. Recognition of such cutaneous involvement is important regarding the diagnosis essentially based on clinical elements. By using some clinical case reports, we will describe several pathologies related to nutritional deficiencies like scurvy, pellagra and acquired acrodermatitis enteropathica.
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Affiliation(s)
- Tatiana Schlomer
- Service de médecine interne, Département de médecine, CHUV, 1011 Lausanne
| | - Julie Di Lucca
- Service de dermatologie, Département de médecine, CHUV, 1011 Lausanne
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11
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Szterenlicht YM, Jarjoui A, Kurd R, Levy L, Munter G. A Peculiar Case of Purpura. Am J Med 2019; 132:934-935. [PMID: 30904505 DOI: 10.1016/j.amjmed.2019.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Yael M Szterenlicht
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Amir Jarjoui
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ramzi Kurd
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ludmila Levy
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Gabriel Munter
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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Irvine I, Walshe T, Capra M, Hayes R. Scurvy: an unusual complication of paediatric cancer treatment. Skeletal Radiol 2019; 48:995-998. [PMID: 30374635 DOI: 10.1007/s00256-018-3103-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 02/02/2023]
Abstract
Scurvy is a disease that is rarely encountered in modern medicine. A condition that was classically associated with sailors, its incidence has decreased dramatically since the discovery of its association with vitamin C deficiency. We present the case of a 2-year-old boy, whose treatment for neuroblastoma was complicated by gastrointestinal disease, which necessitated enteral feeding. While still undergoing treatment, he started to complain about increasing pain in his lower limbs, which appeared to be markedly tender on palpation. Radiographic findings suggested a diagnosis of scurvy, which was subsequently confirmed on serum biochemistry. This was an unexpected finding, as the child had been receiving adequate vitamin C in his enteral feeds. However, his absorption had become severely impaired due to pseudomembranous gastritis and enteritis, leading to his deficient state. He significantly improved after intravenous ascorbic acid replacement and demonstrated a full recovery, both clinically and radiologically. This case highlights the importance of considering scurvy in the differential diagnosis for at-risk patients. Early recognition can facilitate the simple treatment of this potentially serious condition.
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Affiliation(s)
- Iain Irvine
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | - Triona Walshe
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Michael Capra
- Department of Oncology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Roisin Hayes
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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13
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Schweich M, De VA, Sacré F, Bernard V, Michels V. [Scorbut, historic disease ?]. Rev Med Liege 2018; 73:541-543. [PMID: 30431241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Scurvy, a disease caused by a deficit in vitamin C, is again described in Europe nowadays. This condition is associated with poverty and malnutrition, as found in developing countries. However, denutrition may also occur with a "western" lifestyle that can lead to nutriment deficiencies. In the following report is described a case of scurvy in a person suffering from alcoholism.
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Affiliation(s)
- M Schweich
- Gastro-entérologie, CHBA, Liège, Belgique
| | | | - F Sacré
- Gastro-entérologie, CHBA, Liège, Belgique
| | - V Bernard
- Gastro-entérologie, CHBA, Liège, Belgique
| | - V Michels
- Gastro-entérologie, CHBA, Liège, Belgique
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Biesbrouck M, Goddeeris T, Steeno O. Johann Bachoven von Echt (1515-1576) and his work on scurvy: An omen of Vesalius' death? Acta Med Hist Adriat 2018; 16:203-238. [PMID: 30488702 DOI: 10.31952/amha.16.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A discussion is given of the figure of Johann Bachoven von Echt and his family, and on his work on scurvy. The disease is evaluated as a possible cause of the death of Andreas Vesalius. Echt's relationship with Jan Wier and his connections with Vesalius and Metellus are illustrated. A historical overview of the literature on scurvy is provided highlighting the importance of the work of Echtius and Ronsse for the early knowledge of that disease. A report by Metellus on the circumstances of Vesalius' death is added.
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Affiliation(s)
| | | | - Omer Steeno
- Endocrinology - Andrology, Catholic University of Leuven, member of the ISHM
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Affiliation(s)
- Shari Lipner
- Department of Dermatology, Weill Cornell Medical School, New York, NY, USA.
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16
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Abstract
RATIONALE Scurvy is often diagnosed at the state of well-established signs as, for example, skin and visceral purpura, gums involvement, loss of healthy teeth, which derive mostly from disturbance of collagen metabolism. Little is known about the state of latent scurvy, which symptoms are nonspecific and may mimic more common conditions such as weakness, leg pain, and muscle aching. PATIENT CONCERNS We report 3 cases of extreme lassitude and leg pain in alcoholics. In 2 of the 3 cases, discreet classic symptoms such as petechiae or hyperkeratosis of the legs involving collagen metabolism were also present. DIAGNOSES Latent scurvy has been diagnosed thanks to historical experimental data reporting and undetectable ascorbic acid levels. INTERVENTIONS In addition to the treatments recommended by the French Alcohol Society, patients were given oral vitamin C 500 mg to 1000 mg per day for at least three months. OUTCOMES Vitamin C supplementation allowed the regression of the symptoms, greatly improved the quality of life, and gave the possibility to return to work. Cartinine, requiring vitamin C for its hydroxylation, is an essential cofactor in the transport of long-chain fatty acid into mitochondrial matrix. Therefore, it plays an important role in energy production via beta-oxidation. It is thought that carnitine metabolism impairment is responsible for weakness or muscle aching. LESSONS We recommend being aware of the possibility of latent scurvy in chronic alcohol abusers. The vitamin C supplementation and dietetic recommendation eating fresh fruit and vegetables may help to cure tiredness and to return more easily to socialization and to work.
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Abstract
Scurvy was diagnosed in seven children at Boston Children's Hospital. All of the children had a developmental disorder and autism was the most common. They had a long-standing history of food selectivity with diets devoid of fruits and vegetables, and none of the children were supplemented with a multivitamin. They presented with limp, and an elaborate panel of tests and procedures were undertaken before the diagnosis of scurvy was made. Treatment with vitamin C led to rapid recovery of symptoms. This report emphasizes the importance of considering nutritional causes of musculoskeletal symptoms in children with autism and restrictive diets.
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Affiliation(s)
- Nina S Ma
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Cynthia Thompson
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Sharon Weston
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
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18
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Shaath T, Fischer R, Goeser M, Rajpara A, Aires D. Scurvy in the present times: vitamin C allergy leading to strict fast food diet. Dermatol Online J 2016; 22:13030/qt50b8w28b. [PMID: 26990475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023] Open
Abstract
Scurvy results from a deficiency of vitamin C, a nutrient otherwise known as ascorbic acid. Today, scurvy is rare yet emerges in select patients. The patient reported herein developed scurvy secondary to deliberate avoidance of vitamin C-rich foods. Classic cutaneous manifestations of scurvy include follicular hyperkeratosis and perifollicular hemorrhage encompassing coiled "corkscrew" hairs and hairs bent into "swan-neck" deformities. Ecchymoses, purpura, and petechiae are also characteristically prominent. Classic oral abnormalities include erythematous, swollen gingivae that hemorrhage from subtle microtrauma.Subungual linear splinter hemorrhages may also manifest as a sign of the disease. To establish the diagnosis requirements include characteristic physical exam findings, evidence of inadequate dietary intake, and rapid reversal of symptoms upon supplementation. Although unnecessary for diagnosis, histological findings demonstrate perifollicular inflammation and hemorrhage, fibrosis, and hyperkeratosis, amongst dilated hair follicles and keratin plugging. Although citrus fruit allergies have been historically documented, ascorbic acid has not been previously reported as an allergen. Although lacking absolute certainty, this report suggests a presumed case of ascorbic acid allergy based on patient history and favorable response to ascorbic acid desensitization therapy.
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20
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Fain O. [Vitamin C]. Rev Prat 2013; 63:1091-1096. [PMID: 24298827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Vitamin C is a water soluble vitamin which is mainly fresh fruits and vegetables foodborne. Vitamin C deficiency is most often due to a lack of daily amount. Scurvy is characterized by the occurrence of fatigue, myalgia, arthralgia, purpura, bleeding disorders, and later by dental manifestations. Biological signs are nonspecific: anemia, hypocholesterolemia, hypoalbuminemia. Clinical suspicion is confirmed by the decrease in ascorbic acid level (< 2 mg/L). It must be interpreted in light of the acute phase reactants. The treatment is the administration of 1 g of vitamin C per day for 15 days. Vitamin C depletion (ascorbic acid: 2 to 5 mg/L) could induce long-term complications. The recommended dietary allowance of vitamin C protect from these risks.
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Affiliation(s)
- Olivier Fain
- Service de médecine interne, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, université de Paris XIII, 93143 Bondy Cedex, France.
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Delanghe JR, De Buyzere ML, Speeckaert MM, Langlois MR. Genetic aspects of scurvy and the European famine of 1845-1848. Nutrients 2013; 5:3582-8. [PMID: 24036531 PMCID: PMC3798922 DOI: 10.3390/nu5093582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 01/30/2023] Open
Abstract
The view of scurvy being exclusively a nutritional disorder needs to be updated. Genetic polymorphisms of HFE and haptoglobin (Hp) may explain the geographic variability of mortality caused by the European famine of the mid-19th century. In this period, potatoes had fallen victim to the potato blight and Ireland was more severely hit than continental Europe. Hereditary hemochromatosis is a genetic disorder with mutations in the HFE gene, characterized by iron overload (with a reduced vitamin C stability) and with a predominance of affected men. The Irish have the world’s highest frequency of the C282Y mutation and the particular iron metabolism of the Irish helps to understand the size of the catastrophe and the observed overrepresentation of male skeletons showing scurvy. Hp is a plasma α2-glycoprotein characterized by 3 common phenotypes (Hp 1-1, Hp 2-1 and Hp 2-2). When the antioxidant capacity of Hp is insufficient, its role is taken over by hemopexin and vitamin C. The relative number of scurvy victims corresponds with the Hp 2-2 frequency, which is associated with iron conservation and has an impact on vitamin C stability. As iron is more abundant in males, males are overrepresented in the group of skeletons showing scurvy signs.
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Affiliation(s)
- Joris R. Delanghe
- Department of Laboratory Medicine, Ghent University Hospital, B 9000 Ghent, Belgium
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +32-9-332-29-56; Fax: +32-9-332-36-59
| | - Marc L. De Buyzere
- Department of Cardiology, Ghent University Hospital, B 9000 Ghent, Belgium; E-Mail:
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, B 9000 Ghent, Belgium; E-Mail:
| | - Michel R. Langlois
- Department of Laboratory Medicine, AZ Sint Jan Hospital, B 8000 Bruges, Belgium; E-Mail: Michel.
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Mathot BJ, Dees A. A patient with a tumour in the breast and extensive haematomas. Scurvy. Neth J Med 2013; 71:369-373. [PMID: 24038563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- B J Mathot
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands
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23
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Haq RU, Dhammi IK, Jain AK, Mishra P, Kalivanan K. Infantile scurvy masquerading as bone tumour. Ann Acad Med Singap 2013; 42:363-365. [PMID: 23949269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Wilson N, Nghiem N, Summers JA, Carter MA, Harper G. A nutritional analysis of New Zealand military food rations at Gallipoli in 1915: likely contribution to scurvy and other nutrient deficiency disorders. N Z Med J 2013; 126:12-29. [PMID: 23797073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Amongst New Zealand soldiers in Gallipoli in 1915 there were reports of poor food quality and cases of scurvy. But no modern analysis of the military food rations has ever been conducted to better understand potential nutritional problems in this group. METHODS We analysed the foods in the military rations for 1915 using food composition data on the closest equivalents for modern foods. We compared these results with other plausible diets and various optimised ones using linear programming. RESULTS Historical accounts provide evidence for poor food quality supplied to these soldiers. The nutrient analysis suggested that the military rations were below modern requirements for vitamins A, C and E; potassium; selenium; and dietary fibre. If military planners had used modest amounts of the canned vegetables and fruit available in 1915, this would probably have eliminated four of these six deficits. The results from the uncertainty analyses for vitamin C (e.g., 95% uncertainty interval [UI]: 5.5 to 6.7 mg per day), was compatible with the range known to cause scurvy, but the UI for vitamin A intake was only partly in the range for causing night blindness. To indicate the gap with the ideal, an optimised diet (using foods available in 1915), could have achieved all nutrient requirements for under half the estimated purchase cost of the 1915 military rations. CONCLUSIONS There is now both historical and analytic evidence that the military rations provided to these soldiers were nutritionally inadequate in vitamin C, and probably other nutrients such as vitamin A. These deficits are likely to have caused cases of scurvy and may have contributed to the high rates of other illnesses experienced at Gallipoli. Such problems could have been readily prevented by providing rations that included some canned fruit or vegetables (e.g., as manufactured by New Zealand at the time).
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Affiliation(s)
- Nick Wilson
- Department of Public Health, University of Otago, Wellington, PO Box 7343 Wellington South, 6242 New Zealand.
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Zito E, Hansen H, Yeo G, Fujii J, Ron D. Endoplasmic reticulum thiol oxidase deficiency leads to ascorbic acid depletion and noncanonical scurvy in mice. Mol Cell 2012; 48:39-51. [PMID: 22981861 PMCID: PMC3473360 DOI: 10.1016/j.molcel.2012.08.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/16/2012] [Accepted: 08/07/2012] [Indexed: 12/16/2022]
Abstract
Endoplasmic reticulum (ER) thiol oxidases initiate a disulfide relay to oxidatively fold secreted proteins. We found that combined loss-of-function mutations in genes encoding the ER thiol oxidases ERO1α, ERO1β, and PRDX4 compromised the extracellular matrix in mice and interfered with the intracellular maturation of procollagen. These severe abnormalities were associated with an unexpectedly modest delay in disulfide bond formation in secreted proteins but a profound, 5-fold lower procollagen 4-hydroxyproline content and enhanced cysteinyl sulfenic acid modification of ER proteins. Tissue ascorbic acid content was lower in mutant mice, and ascorbic acid supplementation improved procollagen maturation and lowered sulfenic acid content in vivo. In vitro, the presence of a sulfenic acid donor accelerated the oxidative inactivation of ascorbate by an H(2)O(2)-generating system. Compromised ER disulfide relay thus exposes protein thiols to competing oxidation to sulfenic acid, resulting in depletion of ascorbic acid, impaired procollagen proline 4-hydroxylation, and a noncanonical form of scurvy.
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Affiliation(s)
- Ester Zito
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Henning Gram Hansen
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Giles S.H. Yeo
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Junichi Fujii
- Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan
| | - David Ron
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
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Geber J, Murphy E. Scurvy in the Great Irish Famine: evidence of vitamin C deficiency from a mid-19th century skeletal population. Am J Phys Anthropol 2012; 148:512-24. [PMID: 22460661 PMCID: PMC3467765 DOI: 10.1002/ajpa.22066] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/01/2012] [Indexed: 11/18/2022]
Abstract
Scurvy has increasingly been recognized in archaeological populations since the 1980s but this study represents the first examination of the paleopathological findings of scurvy in a known famine population. The Great Famine (1845-1852) was a watershed in Irish history and resulted in the death of one million people and the mass emigration of just as many. It was initiated by a blight which completely wiped out the potato-virtually the only source of food for the poor of Ireland. This led to mass starvation and a widespread occurrence of infectious and metabolic diseases. A recent discovery of 970 human skeletons from mass burials dating to the height of the famine in Kilkenny City (1847-1851) provided an opportunity to study the skeletal manifestations of scurvy-a disease that became widespread at this time due to the sudden lack of Vitamin C which had previously almost exclusively been provided by the potato. A three-scale diagnostic reliance approach has been employed as a statistical aid for diagnosing the disease in the population. A biocultural approach was adopted to enable the findings to be contextualized and the etiology and impact of the disease explored. The results indicate that scurvy indirectly influenced famine-induced mortality. A sex and stature bias is evident among adults in which males and taller individuals displayed statistically significantly higher levels of scorbutic lesions. The findings have also suggested that new bone formation at the foramen rotundum is a diagnostic criterion for the paleopathological identification of scurvy, particularly among juveniles.
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Affiliation(s)
- Jonny Geber
- School of Geography, Archaeology, and Palaeoecology, Queen's University Belfast, Northern Ireland.
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Ben-Shimol S, Greenberg D. [Eat a citrus fruit, stay healthy--a case report of scurvy]. Harefuah 2012; 151:327-380. [PMID: 22991858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Scurvy is a disease that results from a vitamin C deficient diet. Since vitamin C is available in many food products, and especially in citrus fruits, the disease is rare in developed countries. Clinical manifestations of scurvy include general weakness, cutaneous and gum bleeding, pain in the lower limbs and inability to stand and walk (pseudo paralysis). The diagnosis of scurvy requires a high level of clinical suspicion, typical radiographic features and low Levels of vitamin C in the plasma. We report a case of a 7-year-old patient with a medical history of hydrocephalus, failure to thrive and severe psychomotor retardation due to complications of prematurity. On admission she had gum bleeding, severe anemia, pain in the lower limbs and refused to stand and walk. According to her parents, her diet was restricted, without vegetables or fruit consumption. Our investigation ruled out coagulopathy, malignancy and infection. Serum vitamin C levels were low and radiographic findings were consistent with the diagnosis of scurvy. The patient improved rapidly after the initiation of vitamin C supplements. Despite being rare, scurvy should be considered in the differential diagnosis of bleeding and pain in the lower limbs, especially in a malnourished patient.
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Affiliation(s)
- Shalom Ben-Shimol
- Pediatric Ward, The Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Baron JH. Did Lind perform a clinical trial of scurvy in 1747? Eur J Intern Med 2012; 23:e81; author reply e82. [PMID: 22385895 DOI: 10.1016/j.ejim.2011.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stolle LB, Heidemann E, Bischoff-Mikkelsen M. [Scurvy is not entirely a historical disease]. Ugeskr Laeger 2012; 174:499-500. [PMID: 22348673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Scurvy, lack of vitamin C, is a rare disease and is often called seafarers' disease. This case story describes a 36 year-old female patient with scurvy after a gastric bypass operation. Scurvy led to severed bullae on the skin, haemorrhagia and loose skin. After intensive care treatment and a minor split skin graft the patient was discharged from the university hospital to a local hospital for further mobilization. Three months later the patient died due to sepsis.
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Affiliation(s)
- Lars B Stolle
- Plastikkirurgisk Afdeling, Odense Universitetshospital, 5000 Odense, Denmark.
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Maltos AL, Portari GV, Saldanha JC, Bernardes Júnior AG, Pardi GR, da Cunha DF. Scurvy in an alcoholic malnourished cirrhotic man with spontaneous bacterial peritonitis. Clinics (Sao Paulo) 2012; 67:405-7. [PMID: 22522768 PMCID: PMC3317255 DOI: 10.6061/clinics/2012(04)16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- André Luiz Maltos
- Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.
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Abstract
This study outlines the major landmarks in the research on scurvy and its relationship to vitamin C. A thorough search including original manuscripts, books and contemporary reviews published in PubMed was conducted using as keywords "scurvy", "vitamin C", and "history of medicine". Observations on scurvy first appear in Egyptian medical scrolls 3500 years ago, and continue through to the discovery of vitamin C and the modern research on the physiological role of ascorbic acid. The observations of great navigators during the 15th and 16th centuries, when scurvy plagued ships' crews, played an important role in clarifying scurvy's etiology. Among the personalities in the history of the disease, James Lind and Albert Szent-Györgyi are most noteworthy, the first for conducting the first clinical trial on the treatment of scurvy with lemon and orange juices, and the second for discovering and identifying vitamin C.
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Affiliation(s)
- Emmanuil Magiorkinis
- Office for Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Greece.
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Deligny C, Dehlinger V, Goëb V, Baptiste GJ, Arfi S. Paradoxical appearance of adult scurvy in Martinique, French West Indies. Eur J Intern Med 2011; 22:e7-8. [PMID: 21402239 DOI: 10.1016/j.ejim.2010.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/22/2010] [Accepted: 11/25/2010] [Indexed: 11/18/2022]
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Léger D. Scurvy: reemergence of nutritional deficiencies. Can Fam Physician 2008; 54:1403-1406. [PMID: 18854467 PMCID: PMC2567249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- Neelendu Dey
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Mak WM, Thirumoorthy T. A case of scurvy in Singapore in the year 2006. Singapore Med J 2007; 48:1151-1155. [PMID: 18043846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Scurvy is an ancient disease. Over the years, with advances in the understanding of the disease, general improvement in health standards and nutrition, scurvy is now rarely encountered. The few cases of scurvy reported in the 21st century mainly occurred in the neglected elderly, alcoholics and food faddist. We describe scurvy due to food selection in a 37-year-old woman with underlying eating and obsessive-compulsive disorders. With vitamin C replacement, psychiatric medication and cognitive behavioural therapy, there was a dramatic improvement in her condition. This case serves as a reminder to the clinician that, even though rare in today's practice, ascorbic acid deficiency is still encountered, and when recognised, is an easily treatable disease.
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Affiliation(s)
- W M Mak
- Department of Dermatology, Singapore General Hospital, Outram Road, Singapore 169608.
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Berkram P, Bedano PM, Kahi CJ, Illamperuma C, Matthews DE, Antony AC. A landlubber with an ancient mariner's leaky vessels. Gastrointest Endosc 2007; 66:1065-6. [PMID: 17892877 DOI: 10.1016/j.gie.2007.03.1036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 03/12/2007] [Indexed: 12/10/2022]
Affiliation(s)
- Paul Berkram
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abstract
Scurvy is a rarely seen disease resulting from a deficiency of vitamin C. We present a case of scurvy in a 65-year-old man. The patient reported heavy alcohol abuse over the last several years. He also reported that his diet consisted of cheese pizzas only. On physical examination, he was noted to have spontaneous ecchymosis of his lower extremities (denying any history of trauma); poor dentition; and corkscrew hairs on his chest, abdomen, and legs, with associated perifollicular petechia. Punch biopsy of his skin lesions revealed perivascular lymphohistiocytic inflammation, with some focal perifollicular erythrocyte extravasation. A serum ascorbic acid level was <0.12 mg/dL (normal range, 0.20-1.9 mg/dL). A diagnosis of vitamin C deficiency was made. The patient was successfully treated with 1 g/d vitamin C for the first 5 days, followed by a dose of 500 mg/d. Though scurvy is rarely seen in modern times, it is important to identify who is at risk and to recognize the clear and classic signs and symptoms associated with scurvy. Failure to diagnose this disease can potentially lead to expensive and unnecessary medical tests, as well as missing a very simple treatment that can prevent infection and even death.
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Affiliation(s)
- Alan H Wang
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, USA.
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Verma S, Sivanandan S, Aneesh MK, Gupta V, Seth R, Kabra S. Unilateral proptosis and extradural hematoma in a child with scurvy. Pediatr Radiol 2007; 37:937-9. [PMID: 17619184 DOI: 10.1007/s00247-007-0543-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 05/18/2007] [Indexed: 10/23/2022]
Abstract
We report a 3-year-old boy with unilateral proptosis, painful swelling of the right thigh and aphasia. He had radiographic evidence of scurvy in the limbs and bilateral frontal extradural hematomas with a mass lesion in the left orbit on MRI. He was treated with vitamin C and on follow-up 8 weeks later had recovered with no evidence of the orbital mass on clinical or radiological study. Scurvy manifesting as proptosis and extradural hematoma is rare.
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Affiliation(s)
- Sumit Verma
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029
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Abstract
Dialogues in Dermatology, a monthly audio program from the American Academy of Dermatology, contains discussions between dermatologists on timely topics. Commentaries from Dialogues Editor-in-Chief Warren R. Heymann, MD, are provided after each discussion as a topic summary and are provided here as a special service to readers of the Journal of the American Academy of Dermatology.
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Abstract
Nutritional deficiency may be a presenting sign of undiagnosed psychiatric illness. In this case, we present a patient with scurvy as a complication of fixed psychotic delusions regarding his diet. Dermatologists may play a crucial role in the recognition of psychiatric illnesses and appropriate referral for care.
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Abstract
Scurvy is a nearly-forgotten disease in developed countries where adequate nutrition is easily available. It still may occur, however, when, for a variety of reasons, people fail to eat a diet containing adequate vitamin C. We report the case of a 52-year-old patient with depression who developed scurvy.
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Affiliation(s)
- Chen-Wang Chang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan
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Affiliation(s)
- A Des Roches
- Immunology-Allergy Service, Hôpital Ste-Justine 3175 Côte Sainte-Catherine, B Bloc 5 Montréal, Québec Canada H3T 1C5.
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Abstract
BACKGROUND Although much decreased in prevalence, scurvy still exists in industrialized societies. Few recent large studies have examined its pathogenesis, signs, and symptoms. METHODS 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- Jesse M Olmedo
- Department of Dermatology, Division of Regional and International Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA
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Hatuel H, Buffet M, Mateus C, Calmus Y, Carlotti A, Dupin N. Scurvy in liver transplant patients. J Am Acad Dermatol 2006; 55:154-6. [PMID: 16781313 DOI: 10.1016/j.jaad.2005.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2005] [Revised: 09/29/2005] [Accepted: 10/08/2005] [Indexed: 11/30/2022]
Abstract
We report on scurvy in 3 liver transplant recipients. Clinical presentation was limited to ecchymotic purpura and mild follicular keratosis with no mucosal involvement. Skin biopsies suggest vitamin C deficiency, which was confirmed by a low level of vitamin C in both sera and leukocyte specimens. Skin lesions dramatically improved within a few weeks after supplementation with ascorbic acid.
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Affiliation(s)
- Héloïse Hatuel
- Department of Dermatology, Cochin Hospital APHP, Faculty of Medicine Paris 5, University of René Descartes, Paris, France
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Kalk WWI, de Boer J, van der Wouden EJ, Visser A, Vissink A. [A schizophrenic patient with loss of teeth]. Ned Tijdschr Tandheelkd 2006; 113:202-5. [PMID: 16729566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A 53-year-old woman, known with a schizophrenic disorder and a history of drug addiction, was referred because of progressive hematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums, tooth hypermobility and anaemia. Scurvy was diagnosed as a result of an insufficient diet due to drug addiction and a paranoid psychosis. After suppletion of vitamin C and starting highly nutritious food a rapid amelioration of the scurvy related complaints was observed. While dreaded and often fatal in earlier eras, in the 21st century scurvy is easily treatable if this diagnosis is recognised.
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Affiliation(s)
- W W I Kalk
- Afdeling Kaakchirurgie van het Universitair Medisch Centrum Groningen
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Affiliation(s)
- John Pemberton
- Social and Preventive Medicine, The Queen's University of Belfast, Belfast, UK
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