Scurvy.

Area of Science:

• Nutritional disorders
• Biochemistry of collagen synthesis
• Clinical case presentation

Background:

• Scurvy results from prolonged vitamin C deficiency, impacting collagen synthesis and leading to symptoms like fragile blood vessels, poor wound healing, and bleeding.
• Risk factors include malnutrition, low socioeconomic status, alcoholism, smoking, and certain chronic illnesses.
• The disease is underrecognized, especially in developed countries, due to its rarity and the availability of vitamin C in common foods.

Observation:

• A 61-year-old male with alcoholism, smoking, poor diet, and chronic kidney disease presented with fatigue, hypotension, severe anemia, kidney failure, edema, and bleeding.
• Physical examination revealed ecchymoses, perifollicular bleeding, defective teeth, and characteristic 'corkscrew' hair.
• Despite treatment for infections and kidney failure, the patient's condition persisted until vitamin C therapy was initiated.

Findings:

• Administration of oral vitamin C (500 mg daily) led to significant clinical improvement within two weeks, including resolution of skin lesions and improved mobility.
• The rapid recovery confirmed the diagnosis of scurvy, suggesting vitamin C deficiency contributed to the patient's anemia.
• Differential diagnoses included skin infections, hematologic disorders, and collagen vascular diseases, but characteristic signs and rapid response to vitamin C were key.

Implications:

• This case underscores the importance of considering scurvy in patients with risk factors presenting with unexplained fatigue, anemia, bone pain, and mucocutaneous bleeding.
• Clinicians should administer vitamin C empirically in suspected cases without waiting for laboratory confirmation, given its diagnostic and therapeutic role.
• Raising awareness among healthcare professionals is crucial for timely diagnosis and management of this preventable nutritional disorder.