[Scurvy--a mistakenly forgotten disease]

Area of Science:

• Nutrition Science
• Internal Medicine
• Dermatology

Background:

• Scurvy, a condition caused by vitamin C deficiency, is historically associated with long sea voyages but can still manifest in modern developed nations.
• This report details four recent cases of scurvy, highlighting the diverse patient profiles and risk factors present in contemporary society.

Observation:

• The cases involved individuals with significant alcohol and nicotine abuse, malnutrition secondary to food supplement phobia, and malnutrition due to dementia and social isolation.
• Common clinical presentations included adynamia, anemia, dermatologic signs (hemorrhagic hyperkeratosis, cork-screw hair), and periodontal issues.
• Additional symptoms observed were gastrointestinal bleeding, sicca syndrome, retinal bleeding, subdural hematoma, edema, and arthralgia, with associated deficiencies in folic acid and vitamin B12 in some patients.

Findings:

• All four patients exhibited serum ascorbic acid concentrations below the scorbutic threshold of 11 mumol/l.
• The study underscores that scurvy's incidence may be underestimated due to unfamiliarity with its symptoms, which can rapidly resolve with adequate dietary vitamin C.
• Patients at risk include alcoholics, the elderly, psychiatric patients, and individuals with restrictive diets, often presenting with co-existing nutritional deficiencies.

Implications:

• Scurvy remains a relevant clinical diagnosis in developed countries, necessitating awareness among healthcare professionals.
• Early recognition of scurvy's diverse symptomatology is crucial for timely diagnosis and effective, simple treatment.
• Understanding risk factors like social isolation, substance abuse, and specific dietary patterns is key to identifying and managing scurvy proactively.