LB1020 Scurvy: A forgotten illness?

Abstract

Scurvy is classically thought to be a historical disease rarely found in developed countries, thanks to increased awareness of the role of ascorbic acid in this disease. A non-verbal 19-year-old female with a history of developmental delay, G-tube (and by mouth intake), gumline bleeding, and poor dietary intake, presented with bilateral lower extremity non-palpable petechial, perifollicular eruptions. She denied any significant pain, itch, or irritation from the rash. Perifollicular petechiae and scattered corkscrew hairs were found on dermoscopy examination. A suspicion of Scurvy from her history and physical examination was confirmed by the serum levels of vitamin C <0.1 mg/dL. Although, the diagnosis is clinical, a histopathologic examination showed hyperkeratosis with irregular acanthosis of the epidermis and follicular spongiosis with erythrocyte extravasation adjacent to a hair follicle consistent with Scurvy. Scurvy is a well-documented disease caused due to a deficiency in Vitamin C, a known cofactor of enzymes involved in the synthesis of collagen, carnitine and catecholamines, and in gene expression and maintenance. Thorough dermascopic examination will reveal symptoms such as perifollicular petechiae and corkscrew hairs1 - some of the diagnostic clues to lack of functioning collagen, that occur with Scurvy. Other symptoms of collagen dysfunction include gingival bleeding, ecchymosis, epistaxis, and bone hemorrhage. In developed countries, patients with avoidant-restrictive food intake or those with renal imbalances are at risk of acquiring Scurvy. Therefore, it is important to keep Scurvy in the differentials in patients presenting with petechiae and perform a comprehensive physical exam, to avoid misdiagnosis. 1. Hirschmann, J.V. and G.J. Raugi, Adult scurvy. J Am Acad Dermatol, 1999. 41(6): p. 895-906; quiz 907-10. https://doi.org/ 10.1016/s0190-9622(99)70244-6.