Scurvy: A Case Report and Literature Review.

Jason M Thomas,Kathryn M Burtson

doi:10.7759/cureus.14312

Abstract

Scurvy is a rare disease which can manifest in a variety of presentations. Classically, scurvy is associated with poor dentition and bleeding diatheses. Rarely, scurvy can present with life-threatening hemodynamical instability.Herein, we report the case of a 69-year-old female with a history of hypertension and depression who presented with four months of weakness and a 20-pound weight loss. Her presentation was complicated by lower extremity bruising and myalgias over the last three weeks. The patient’s blood pressure in the emergency department was 86/54 mmHg. On further examination, she had poor dentition and extensive ecchymoses in different stages of resolution over her posterior thighs and calves. The patient was also noted to have perifollicular hemorrhages. An ascorbic acid level was checked and the result was 0.0 mg/dL (normal range: 0.4 to 2.0 mg/dL). During her admission, she slowly improved with a provided diet and multivitamins. Her blood pressure consistently remained over 120/65 mmHg. The patient was advised to adjust her diet and take supplemental ascorbic acid. On a follow-up visit two weeks later, the patient endorsed an improvement in pain and exercise tolerance and was noted to have marked improvement in skin findings. Ascorbic acid is an essential piece of multiple biochemical pathways. Humans are required to attain ascorbic acid from their diet. People who consume diets lacking in ascorbic acid develop scurvy.

Highlights

Scurvy is a re-emerging disease of antiquity that can be debilitating and cause life-threatening hemodynamic instability
An ascorbic acid level less than 10 mg/dL is associated with petechial hemorrhage, follicular hyperkeratosis, failure of wound healing, anemia, loosened teeth, and bleeding gums
Clinicians must be aware of signs and symptoms of scurvy and the importance of ascorbic acid in hemodynamic stability

Summary

Introduction

Scurvy is a re-emerging disease of antiquity that can be debilitating and cause life-threatening hemodynamic instability. In the 2003-2004 National Health and Nutrition Examination Survey, 7.1 ± 0.9% of the total population was found to have vitamin C deficiency [1] Despite this prevalence, there are rare reports of manifest scurvy in the United States in the last 30 years. A 69-year-old female with a history of hypertension and depression presented with a four-month history of weakness and a 20-pound weight loss She had associated symptoms of lower extremity bruising and myalgias over the previous three weeks. An ascorbic acid level was checked and resulted at 0.0 mg/dL (normal range: 0.4 to 2.0 mg/dL) During her admission, the patient slowly improved with a provided diet and daily multivitamins. On a follow-up visit two weeks later, the patient endorsed an improvement in pain and exercise tolerance and was noted to have marked improvement in skin findings (Figure 3)

Discussion

Findings

Disclosures