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Scurvy Is Still Present in Developed Countries

  • Case Reports/Clinical Vignettes
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Abstract

Introduction

Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.

Objective

We report the case of a 57-year-old male who presented with a combined vitamin C deficiency (scurvy) and a Zinc deficiency.

Interventions

He came to the emergency department complaining of a painful swollen ecchymotic leg and dyspnea. Prescriptions for narcotics did not relieve his symptoms. When a detailed dietary history was obtained, we added scurvy to the differential diagnosis. An extensive evaluation excluded trauma, coagulopathies, neoplasia, and vasculitides.

Main Result

The combination of a classic skin biopsy and a low vitamin C level confirmed the diagnosis.

Conclusion

This presentation illustrates the necessity of including scurvy in the differential diagnosis of ecchymoses and demonstrates specific populations at risk: single adults and the elderly with deficient diets.

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References

  1. Milne I , Chalmers I. Documenting the evidence: the case of scurvy. Bull World Health Organ. 2004;82:791–6.

    PubMed  Google Scholar 

  2. Martini E. How did Vasco de Gama sail for 16 weeks without developing scurvy? Lancet. 2003;361:1480.

    Article  PubMed  Google Scholar 

  3. Pimentel L. Scurvy; historical review and current diagnostic approach. Am J Emerg Med. 2003;21:328–32.

    Article  PubMed  Google Scholar 

  4. Lind J. A treatise of the scurvy in three parts: containing an inquiry into the nature causes and cure, of the disease together with a critical and chronological view of what has been published on the subject. In: Stewart CP, Guthrie D, eds. Sands. Murray-and-Cochran: Edinburgh; 1953:145–8.

    Google Scholar 

  5. Assefa F , Jabarkhil MZ , Salama P , Spiegel P. Malnutrition and mortality in Kohistan District, Afghanistan, April 2001. JAMA. 2001;286:2723–8.

    Article  PubMed  CAS  Google Scholar 

  6. Hampl JS , Taylor CA , Johnston CS. Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994. Am J Public Health. 2004;94:870–5.

    PubMed  Google Scholar 

  7. Schneider JB , Norman RA. Cutaneous manifestations of endocrine-metabolic disease and nutritional deficiency in the elderly. Dermatol Clin. 2004;22:23–31.

    PubMed  Google Scholar 

  8. Vairo G , Salustri A , Trambaiolo P , D’Amore F. Scurvy mimicking systemic vasculitis. Minerva Med. 2002;93:145–50.

    PubMed  CAS  Google Scholar 

  9. Safa G , Pieto-Le Corvaisier CH , Cadiou C , Pasquiou A , Rivoallan N. Survey in 2000: 3 cases. Ann Dermatol Venereol. 2001;128:1225–8.

    PubMed  CAS  Google Scholar 

  10. Adelman HM , Wallach PM , Gutierrez F , et al. Scurvy resembling cutaneous vasculitis. Cutis. 1994;54:111–4.

    PubMed  CAS  Google Scholar 

  11. Haboubi NY , Haboubi NA , Gyde OH , Small NA , Barford AV. Zinc deficiency in senile purpura. J Clinic Pathol. 1985;38:1189–91.

    Article  CAS  Google Scholar 

  12. Hunder GG. Classification of and approach to the vasculitides in adults. Up To Date. http://www.uptodate.com. Accessed February 2007.

  13. Olmedo JM , Yiannias JA , Windgassen EB , Gornet MK. Scurvy: a disease almost forgotten. Int J Dermatol. 2006;45:909–13.

    Article  PubMed  Google Scholar 

  14. Francescone MA , Levitt J. Scurvy masquerading as leukocytoclastic vasculitis: a case report and review of the literature. Cutis. 2005;76:261–66.

    PubMed  Google Scholar 

  15. De Luna RH , Colley BJ , Smith K , Divers SG , Rinehart J , Marques MB. Scurvy an often forgotten cause of bleeding. Am J Hematol. 2003;73:85–7.

    Article  Google Scholar 

  16. Marcellini F , Giuli C , Papa R , et al. Zinc status, psychological and nutritional assessment in old people recruited in five European countries: Zincage study. Biogerontology. 2006;7:339–45.

    Article  PubMed  CAS  Google Scholar 

  17. Pazirandeh S, Lo CW, Burns DL. Overview of water-soluble vitamins. Up To Date. http://www.uptodate.com Accessed February 2007.

  18. Thomas DR. Vitamins in health and aging. Clin Geriatr Med. 2004;20:259–74.

    Article  PubMed  Google Scholar 

  19. Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol. 2005;6:165–73.

    Article  PubMed  Google Scholar 

  20. Herbein G , Varin A , Fulop T. NF-kappaB, Ap-1, Zinc deficiency and aging. Biogerontology. 2006;7:409–19.

    Article  PubMed  CAS  Google Scholar 

  21. Warshauer DM , Hayes ME , Shumer SM. Scurvy: a clinical mimic vasculitis. Cutis. 1984;34:539–41.

    PubMed  CAS  Google Scholar 

  22. Kasarskis EJ , Schuna A. Serum alkaline phosphatase after treatment of zinc deficiency in humans. Am J Clin Nutr. 1980;33:2609–12.

    PubMed  CAS  Google Scholar 

  23. Tamura Y , Welch DC , Zic JA , Cooper WO , Stein SM , Hummell DS. Scurvy presenting as painful gait with bruising in a young boy. Arch Pediatr Adolesc Med. 2000;154:732–5.

    PubMed  CAS  Google Scholar 

  24. Schectman G , Byrd JC , Gruchow HW. The influence of smoking on vitamin C status in adults. Am J Public Health. 1989;79:158–62.

    Article  PubMed  CAS  Google Scholar 

  25. Adzersen KH , Jess P , Freivogel KW , Gerhard I , Bastert G. Raw and cooked vegetables, fruits, selected micronutrients, and breast cancer risk: a case-control study in Germany. Nutr Cancer. 2003;46:131–7.

    Article  PubMed  CAS  Google Scholar 

  26. Nursal B , Yücecan S. Vitamin C losses in some frozen vegetables due to various cooking methods. Nahrung. 2000;44:451–3.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Robert M. Centor MD.

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Velandia, B., Centor, R.M., McConnell, V. et al. Scurvy Is Still Present in Developed Countries. J GEN INTERN MED 23, 1281–1284 (2008). https://doi.org/10.1007/s11606-008-0577-1

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  • DOI: https://doi.org/10.1007/s11606-008-0577-1

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