Diagnosis Of Scurvy Research Articles

The Troubling Rise of Scurvy: A Review and National Analysis of Incidence, Associated Risk Factors, and Clinical Manifestations.

In the era of modern medicine, scurvy has been thought of as a rare disease of ancient times because of improved emphasis on diet and nutrition; however, isolated case reports are plentiful. This investigation presents a comprehensive review of scurvy, including an analysis on its rising incidence, with specific focus on its orthopaedic manifestations and commonly associated diagnoses. This comprehensive review includes a retrospective analysis of 19,413,465 pediatric patients in the National Inpatient Sample database from 2016 through 2020. Patients with scurvy were identified by the ICD-10 code, and an estimated incidence of scurvy in the inpatient pediatric population was calculated. Concurrent diagnoses, musculoskeletal reports, and demographic variables were collected from patient records. Comparisons were made using analysis of variance or chi-square with Kendall tau, where appropriate. The incidence of scurvy increased over the study period, from 8.2 per 100,000 in 2016 to 26.7 per 100,000 in 2020. Patients with scurvy were more likely to be younger (P < 0.001), male (P = 0.010), in the lowest income quartile (P = 0.013), and obese (P < 0.001). A majority (64.2%) had a concomitant diagnosis of autism spectrum disorder. Common presenting musculoskeletal reports included difficulty walking, knee pain, and lower limb deformity. Burden of disease of scurvy was markedly greater than that of the average inpatient population, with these patients experiencing greater total charges and longer hospital stays. Clinicians should be aware of the increasing incidence of scurvy in modern medicine. In cases of vague musculoskeletal reports without clear etiology, a diagnosis of scurvy should be considered, particularly if risk factors are present. NA.

Analysis of the Role of Vitamin C Hypovitaminosis in Scurvy on Bone Health: A Single Center Observational Study at Dr. Moewardi General Hospital, Surakarta, Indonesia

Background: Scurvy, vitamin C deficiency, is a rare condition but remains relevant in Indonesia. This study aims to analyze the role of vitamin C hypovitaminosis in the development of scurvy and its impact on bone health through an observational study at Dr. Moewardi General Hospital. Surakarta. Methods: A cross-sectional observational study was conducted on 30 patients diagnosed with scurvy at Dr. Moewardi General Hospital Surakarta during the 2020-2023 period. Demographic data, medical history, nutritional status, and severity of scurvy were collected. A radiological examination of the bone is performed to assess scurvy-related changes. Descriptive, comparative, and Spearman correlation statistical analyzes were used. Results: The majority of patients were men (66.7%) with a mean age of 45 years. A history of an unbalanced diet with low fruit and vegetable intake was found in the majority of patients (86.7%). Common symptoms include fatigue (86.7%), joint pain (73.3%), bleeding gums (60%), and skin bleeding (53.3%). The severity of scurvy varied, with 10 patients (33.3%) experiencing severe scurvy. Radiological examination shows significant changes in long bones, especially osteoporosis and thinning of the cortex, which is more obvious in patients with severe scurvy. Spearman correlation analysis showed a positive correlation between the severity of scurvy and the incidence of osteoporosis (rho = 0.495, p = 0.005) and cortical thinning (rho = 0.394, p = 0.031). Conclusion: Vitamin C hypovitaminosis plays a significant role in the development of scurvy and has a negative impact on bone health. Early screening and diagnosis of scurvy are important to prevent musculoskeletal complications. Nutritional education and dietary interventions to increase vitamin C intake need to be intensified, especially in high-risk groups.

Scurvy in Children: A Case Report

Scurvy is all the symptoms associated with a diet deficient in ascorbic acid or vitamin C, found in fresh fruit and vegetables. Scurvy is a pathology resulting from a deep and prolonged vitamin C deficiency, which can manifest itself as a bleeding syndrome, wound healing disorders, rheumatic signs, or gum damage. If left untreated (vitamin C supplementation), the disease can be fatal. This water-soluble vitamin is neither synthesized nor stored in the body. In recent years, there has been a resurgence of this pathology due to unbalanced nutrition. Clinical presentations are deceptive and variable, with orthopedic abnormalities and a diffuse hemorrhagic syndrome secondary to a defect in collagen fiber synthesis in children. The diagnosis of scurvy is confirmed by measuring ascorbemia, which is less than 2 mg/L (5-15 mg/L or 17-94 mmol/L), and treatment is based on vitamin C supplementation at 100 to 300 mg/day until complete recovery. We report the case of a 7-year-old patient with an autistic spectrum disorder associated with epilepsy, who presented with scurvy revealed by bone involvement consisting of bone pain, a bleeding syndrome and gingival hypertrophy in context of altered general condition. The diagnosis was confirmed by a collapsed ascorbic acid level (&amp;lt;3 mmol/l) and progressed favorably on vitamin supplementation.

Evidence of non-adult vitamin C deficiency in three early medieval sites in the Jaun/Podjuna Valley, Carinthia, Austria

ObjectiveThis study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria. Materials86 non-adult individuals were assessed from three early medieval sites. MethodsMorphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20–40x magnification. ResultsA significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults. ConclusionsIn this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy. SignificanceThis study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process. LimitationsPoor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth. Suggestions for further researchFuture applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies.

Lessons learned from "the great mimicker disease": A retrospective study of 18 patients with scurvy.

Scurvy is an uncommon medical condition that affects children and is caused by an inadequate intake of vitamin C. This study presents the characteristics of patients with scurvy to raise awareness of the diagnostic process in developing countries where laboratory testing for vitamin C levels is often not available. A retrospective study was performed from period of 2018 to 2023. Data extraction includes patient age, sex, body mass index, constitutional symptoms, musculoskeletal, mucosal, cutaneous symptoms, other accompanying disorders, anemia, erythrocyte sedimentation rate, C-reactive protein, radiographic examination, vitamin C dose, and duration of treatment. Descriptive statistical analysis was performed in this study. Eighteen cases (17 males, 1 female) of scurvy were referred to our institution. Thirteen of 18 patients were misdiagnosed before referral. The median age at presentation was 4.5 (range, 2-11) years. The average body mass index was 13.93 ± 0.63 kg/m2. Half of patients had healthy weight. All patients presented with lower limb pain and 17 of 18 with refusal to walk. The median onset of diagnosis was 11 (range 4-48) weeks. White line of Frankel was described in all patients. Seven had anemia and 6 of 18 had increase in erythrocyte sedimentation rate and/or C-reactive protein levels. Only one patient had ascorbic acid levels evaluation before treatment since it was not readily available in our country. Treatment length varied from 2 weeks to 6 months. The diagnosis of scurvy is frequently delayed due to its extreme rarity in modern society and its ability to mimic numerous other conditions. In children presenting with limb pain and/or reluctance to walk and pathognomonic radiological findings, physicians must prioritize scurvy as a differential diagnosis. In scurvy, vitamin C supplementation is curative.

Scurvy, anaemia, and rickets under the microscope - Light-microscopy supported investigation of malnutrition in subadult skeletal remains from the medieval central mountain village of Winnefeld (Lower Saxony, Germany).

In the hilly region of Solling in Central Germany, a large number of abandoned medieval settlements is known. In an excavation project of a church ruin and cemetery of the abandoned village Winnefeld from the 12th to 14th century CE, 165 individuals were excavated and anthropologically examined, including a light microscopic investigation. Among these individuals, 105 subadults were identified, from the age-at-death of pre-natal (stillborn) infants, up to juveniles, with the large majority of infants up to two years of age-at-death. Among the subadults, scurvy was frequently diagnosed. In more than 30% of the individuals, evidence or at least hints towards the diagnosis of scurvy were observed. Anaemia and rickets were less frequent (about 6% and 7%), however, still common. The light microscopic investigation, conducted as series standard, proved itself as a useful additional method in distinguishing vestiges of different illnesses, especially in non-extreme, questionable cases. Sometimes, however, it even resulted in a change of diagnosis of formerly supposed "clear" cases.

Scurvy in Children: The Silent Masquerader.

In modern society, scurvy is well known in its historical perspective rather than clinical relevance. Scurvy is classically thought to manifest with signs of 'bleeding painful gums' in the undernourished. Little is known regarding its ability to mimic a wide range of rheumatological, orthopaedic, neurological and haematological illnesses. Due to the rarity of its occurrence, there is a poor understanding among present-day clinicians, and so scurvy can easily deceive the uninitiated. We report a school-aged boy with normal neurodevelopment who presented with lower limb pain and difficulty in walking. He was seen by multiple specialist doctors before the clinical diagnosis of scurvy was made by a general paediatrician. Investigations showed that this child had X-ray changes typical of scurvy with low serum ascorbic acid levels. On supplementation with vitamin C, he showed dramatic improvement in symptoms and gradually achieved complete recovery.

Scurvy: A Case Report

Scurvy is a rare case found in many countries, but it is often found in refugeeareas, especially in Africa. Vitamin C deficiency varies based on season and occursmore in men with age. The purpose of this research is to avoid misdiagnosis so thatit can be a reference in the field of medicine to diagnose and provide managementon scurvy. This prospective research was conducted with one sample of research.Observation had been carried out for two months, starting at one month after thepatient was suspected with the diagnosis of scurvy. Computer Tomography (CT)Scan lumbosacral to pelvic results were normal. Laboratory test of HB result was9.5 g/dl, in which MCV was 63.2 fL, MCH was 20.3 pg, and MCHC was 32.1 g/dl.Scurvy treatment in the first visit was 3x1 tablets vitamin C, 3x5 ml ibuprofen Syr,and physiotherapy. The results were that the patient still suffered swollen andbleeding gums, but the pain no longer existed, pale, behavioural disorders, unableto walk, and pain in both knees. After the second visit, the child got therapy of 4x50mg vitamin C, 1x1 tablets vitamin B12, 1x150 IU vitamin E, 1x1 tablets cavit D3,and physiotherapy. After two weeks of treatment, there were no complaints ofswelling, painful or bleeding gums. The child could straighten her legs, but she wasstill unable to walk due to the trauma of feeling great pain while walking. Specialattention is required to diagnose appropriately so the doctor can minimize andprevent complications.

The oral manifestations of scurvy in the 21st century

Scurvy is a vitamin deficiency historically associated with pirates and sailors that affects collagen synthesis, leading to hemorrhage, skin, and oral lesions. In the 18th century, the lack of consumption of foods rich in vitamin C was found to cause such a severe condition, whose early diagnosis increases the likelihood of a better prognosis. A 58-year-old female patient complained of fatigue, body pain, and gingival bleeding for nearly 24 months. In 2001, she was diagnosed with lupus, now in remission, and osteoporosis more recently. On clinical examination, gingivitis with spontaneous bleeding was observed, despite the patient’s good hygiene, as well as some petechiae over the body. Due to the hypothesis of a possible autoimmune dermatological disease, the patient was referred to a dermatologist, who requested a series of tests, including vitamin C dosage. The results showed a concentration below 0.25mg / dL (IR, 4 to 2.0 mg / dL), and thus the diagnosis of scurvy was established. The patient was administered vitamin C replacement and in about 3 months, the symptoms started to improve. In some cases, such as this, hospitalization is required for intravenous replacement due to bleeding risks. This case report highlights the importance of the dentist in the early diagnosis and treatment of scurvy. This condition causes oral lesions that are often confused with other more common conditions, such as gingivitis or autoimmune dermatological response. Therefore, we recommend a comprehensive physical examination and anamnesis, including dietary history.

Atypical Presentation of Vitamin C Deficiency Manifesting as Petechial Hemorrhaging

A 62-year-old man with history of cigarette smoking presented with fatigue, lightheadedness, exertional dyspnea, lower extremity swelling, ecchymoses, and petechiae. There was no history of trauma, infection, new medications, or abnormal diet. Physical exam revealed red petechial 3-5mm macules and pink-violaceous purpuric indurated patches over the bilateral upper and lower extremities, buttocks, and lower abdomen. Corkscrew hairs were noted on the bilateral lower extremities. Laboratory studies were significant for anemia and elevated acute phase reactants. Thiamine, folate, and vitamin B12 were within normal limits. Workup for thrombocytopenia, platelet dysfunction, coagulopathies, hemolysis, vasculitidies, liver or gastrointestinal disease, rheumatologic disorders, and bone marrow disorders was negative. Skin biopsy and histology revealed dermal extravasated erythrocytes without evidence of vasculitis or thrombi. Ascorbic acid plasma concentration was then tested and below the limit of detection on hospital day six. A diagnosis of scurvy was made, and the patient was discharged on 1000mg Vitamin C daily supplementation. At two-week follow up, constitutional symptoms were resolved, anemia corrected, and cutaneous symptoms improving. The medical, hematology, and dermatology teams did not originally suspect a vitamin C deficiency in this patient. This case emphasizes the importance of the consideration of scurvy on the differential of petechiae, even in patients who do not present with the typical risk factors or features. Medical providers should consider scurvy, particularly in patients at risk for malnutrition due to chronic conditions and/or history of alcohol or tobacco use disorder.

Scurvy: A Case Report

Scurvy is a rare case found in many countries, but it is often found in refugee areas, especially in Africa. Vitamin C deficiency varies based on season and occurs more in men with age. The purpose of this research is to avoid misdiagnosis so that it can be a reference in the field of medicine to diagnose and provide management onscurvy. This prospective research was conducted with one sample of research. Observation had been carried out for two months, starting at one month after the patient was suspected with the diagnosis of scurvy. Computer Tomography (CT) Scan lumbosacral to pelvic results were normal. Laboratory test of HB result was 9.5 g/dl, in which MCV was 63.2 fL, MCH was 20.3 pg, and MCHC was 32.1 g/dl. Scurvy treatment in the first visit was 3x1 tablets vitamin C, 3x5 ml ibuprofen Syr, and physiotherapy. The results were that the patient still suffered swollen and bleeding gums, but the pain no longer existed, pale, behavioural disorders, unable to walk, and pain in both knees. After the second visit, the child got therapy of 4x50 mg vitamin C, 1x1 tablets vitamin B12, 1x150 IU vitamin E, 1x1 tablets cavit D3, and physiotherapy. After two weeks of treatment, there were no complaints of swelling, painful or bleeding gums. The child could straighten her legs, but she was still unable to walk due to the trauma of feeling great pain while walking. Special attention is required to diagnose appropriately so the doctor can minimize and prevent complications.

A Bendable Biofuel Cell-Based Fully Integrated Biomedical Nanodevice for Point-of-Care Diagnosis of Scurvy.

Fully integrated nanodevices that allow the complete functional implementation without an external accessory or equipment are deemed to be one of the most ideal and ultimate goals for modern nanodevice design and construction. In this work, we demonstrate the first example of a bendable biofuel cell (BFC)-based fully integrated biomedical nanodevice with simple, palm-sized, easy-to-carry, pump-free, cost-saving, and easy-to-use features for the point-of-care (POC) diagnosis of scurvy from a single drop of untreated human serum (down to 0.2 μL) by integrating a bendable and disposable vitamin C/air microfluidic BFC (micro-BFC) (named iezCard) for self-powered vitamin C biosensing with a custom mini digital LED voltmeter (named iezBox) for signal processing and transmission, along with a ″built-in″ biocomputing BUFFER gate for intelligent diagnosis. Under the simplicity- and practicability-oriented idea, a cost-effective strategy (e.g., biomass-derived hierarchical micro-mesoporous carbon aerogels, screen-printed technique, a single piece of Kimwipes paper, LED display, and universal components) was implemented for nanodevice design rather than any top-end or pricey method (e.g., photolithography/electron-beam evaporation, peristaltic pump, wireless system, and 3D printing technique), which enormously reduces the cost of feedstock down to ∼USD 2.55 per integrated kit including a disposal iezCard (∼USD 0.08 per test) and a reusable iezBox (∼USD 2.47 for large-scale tests). These distinctive and attractive features allow such a fully integrated biomedical nanodevice to fully satisfy the basic requirements for POC diagnosis of scurvy from a single drop of raw human serum and make it particularly appropriate for resource-poor settings, where there is a lack of medical facilities, funds, and qualified personnel.

The Forgotten Story of Vitamin C Deficiency

Vitamin C plays an essential role in the formation of collagen. A deficiency in vitamin C can lead to scurvy, manifested by blood vessel fragility, fatigue, and, rarely, death. Today, scurvy is rare in developed countries. Therefore, to diagnose scurvy requires a high index of suspicion. This will be illustrated by our patient of interest. A 66-year-old man presented to the emergency department (ED) with worsening bilateral leg swelling and bruising throughout his body. His past medical history was notable for a bowel resection with colostomy secondary to colorectal cancer, currently in remission. The bruising and swelling began two weeks prior without any inciting events. He denied taking blood thinners or non-steroidal-anti-inflammatory-drugs. He had no personal or family history of bleeding disorders. None of his previous surgeries were complicated by bleeding issues. Extremities showed large ecchymoses over left thigh and bilateral ankles, and hematoma over right patella. There were no perifollicular hemorrhages seen on skin examination. His hemoglobin was 13.5 g/dL and his platelet count was 145x109/L. A computed tomography angiography of his lower extremities revealed intramuscular hematomas in the calves, left adductor compartment and left sartorius. A venous ultrasound of bilateral lower extremities was unremarkable. He was advised to follow up with a hematologist outpatient. Ten days later, the patient reported worsening swelling and pain of his lower extremities and was advised to visit the ED (FIGURE 1A). His Hgb dropped to 10.8 g/dL. An extensive factor workup showed: factor VIII activity of 421.7% (ref range: 55-200), factor IX activity of 104% (ref range: 70-130), factor XI activity of 68% (ref range: 55-150), and von Willebrand factor activity of 355% (ref range: 55-200). Factor V, X and XIII were within normal limits. Other possible etiologies including vitamin K, HIV, hepatitis panel, antinuclear antibody and extractable nuclear antigen antibodies panel were normal. His activated partial thromboplastin time (aPTT) was prolonged at 44 seconds (ref range 25-37). The dilute Russel's viper venom time (dRVVT) was abnormal and his dRVVT/dRVVT-phospholipid ratio was greater than 1.3 or greater, indicative of a lupus anticoagulant. Beta-2 glycoprotein 1 antibodies and anticardiolipin antibodies were normal. Bleeding due to prothrombin (factor II) deficiency in the context of lupus anticoagulant has been reported (2). However, his factor II level was normal. Meanwhile, his Hgb fell to 6.9 g/dL, indicative of ongoing intramuscular bleeding. Upon further investigation by the consulting hematology team and registered dietitian, there was a concern for severe malnutrition, evident by substantial loss of subcutaneous fat and muscle mass. The patient revealed that he consumed six twelve-ounce cans of beers nightly. His diet was minimal in fruits and vegetables. One month prior to his admission, he had worsening fatigue, brittle nails and gum bleeding. His folate level was 2.0 ng/mL (ref range &amp;gt;3.9) and his albumin level dropped to 2.1 g/dL (ref range 3.5-5). His vitamin C level resulted &amp;lt; 0.1 mg/dL (ref range 0.4-2). He was started on three days of intravenous vitamin C, one gram per day. His hematoma and bruises dramatically improved (FIGURE 1B). As a result, a diagnosis of scurvy was made. On discharge, he was transitioned to oral vitamin C and advised to follow up with his hematologist outpatient. Scurvy is often viewed as a disease of the past. Yet, according to a national survey between 2003 and 2004, the prevalence of age-adjusted vitamin C deficiency is 7%. At risk patients include the elderly, institutionalized populations, alcoholics, and severe psychiatric illness leading to poor nutritional intake. Therefore, a dietary history of the patient should be obtained. Vitamin C contributes to the structure of blood vessels through its involvement in collagen synthesis. Characteristic signs and symptoms of scurvy feature fatigue, oral findings (spontaneous bleeding, gum retraction) and cutaneous abnormalities (petechiae and lesions). Rarely, it can lead to spontaneous intramuscular hematoma. The prognosis of scurvy is excellent, and the response to vitamin C is dramatic. This case illustrates the need to consider scurvy in diagnosing bleeding cases. A high index of suspicion remains integral in diagnosing scurvy to avoid expensive and lengthy workup. Disclosures No relevant conflicts of interest to declare.

Vitamin C deficiency mimicking inflammatory bone disease of the hand

BackgroundSevere vitamin C deficiency, or scurvy, encompasses a syndrome of multisystem abnormalities due to defective collagen synthesis and antioxidative functions. Among the more common presentations is a combination of oral or subcutaneous hemorrhage with lower extremity pain, the latter often exhibiting inflammatory bone changes on magnetic resonance imaging (MRI).Case presentationA 12-year-old male with anorexia nervosa presented with asymmetric painful swelling of multiple fingers of both hands. Imaging demonstrated soft tissue and bone marrow edema of several phalanges, without arthritis, concerning for an inflammatory process. Extensive imaging and laboratory evaluations were largely unrevealing, with the exception of a severely low vitamin C level and a moderately low vitamin D level. A diagnosis of scurvy was made and supplementation was initiated. Within 3 weeks of treatment, serum levels of both vitamins normalized and the digital abnormalities resolved on physical exam.ConclusionsThis represents the first description of scurvy manifesting with bone and soft tissue changes limited to the hands. There must be a high index of suspicion for scurvy in children with restricted dietary intake or malabsorption who have bone pain, irrespective of location of the lesions.

Scurvy: An Unexpected Nutritional Complication in an Adolescent Female With Anorexia Nervosa

Vitamin C deficiency results in the clinical presentation of scurvy, a disease that is rare among the adolescent population. Individuals with unusual dietary habits, mental illness, or physical disability are more prone to develop scurvy. We present a case report of a previously healthy 16-year-old female presented to the hospital with a 12-month history of anorexia nervosa, restrictive subtype. She was admitted to the intensive care unit and transferred to a tertiary care pediatric eating disorder program for the treatment of extreme weight loss, cardiovascular instability, and refeeding syndrome. On examination, she had multiple tiny hyperpigmented perifollicular petechial papules on the lower abdomen, dorsum thighs, and extensor surfaces of the arms with corkscrew hairs on the abdomen. Dermatologic examination and laboratory investigations were consistent with a diagnosis of scurvy. The patient's vitamin C serum level was 21 μmol/L (.23 mg/dL; reference range 25–114 μmol/L [.28–1.28 mg/dL]). She was treated with ascorbic acid orally. Objective cutaneous findings improved within 4 weeks of supplementation, and after 6 weeks, repeat levels of vitamin C levels were 102 μmol/L (1.15 mg/dL). To the best of our knowledge, this is the first case of an adolescent female with anorexia nervosa and cutaneous manifestations of scurvy that resolved after the oral administration of vitamin C.

Scurvy may occur even in children with no underlying risk factors: a case report

BackgroundSince ancient times, scurvy has been considered one of the most fearsome nutritional deficiency diseases. In modern developed countries, this condition has become very rare and is only occasionally encountered, especially in the pediatric population. Underlying medical conditions, such as neuropsychiatric disorders, anorexia nervosa, celiac disease, Crohn disease, hemodialysis, and severe allergies to food products may enhance the risk of developing scurvy.Case presentationWe report the case of an otherwise healthy 3-year-old white boy who developed scurvy due to a selective restrictive diet derived from his refusal to try new food. He presented to our clinic with asthenia and refusal to walk. During hospitalization he developed severe anemia and hematochezia. A diagnosis of scurvy was assessed on the basis of nutritional history, clinical features, radiographic findings, and laboratory findings. Supplementation of ascorbic acid enabled a prompt resolution of symptoms.ConclusionsScurvy is caused by vitamin C deficiency. Cutaneous bleeding, mucosal bleeding, and anemia represent typical manifestations of the disease. These symptoms are directly connected to ascorbic acid involvement in collagen biosynthesis. Some radiographic findings can be useful for the diagnosis. Treatment aims to normalize serum levels of vitamin C in order to counteract the deprivation symptoms. The present case report demonstrates that scurvy may sporadically occur in pediatric patients, even in individuals with no predisposing medical conditions and/or potential risk factors.

Scurvy, an old story in a new time: The hematologist's experience

BackgroundScurvy is a rare entity in developed countries and the diagnosis may often be delayed resulting in unnecessary investigations and/or potentially severe complications. A recent increase in the number of patients diagnosed with scurvy in our hematology clinics indicated the need to review the literature on the diagnosis and optimal management of similar patients. MethodsWe conducted a retrospective chart review of patients referred to hematology at our tertiary care centre between 2010 and 2018, who were ultimately diagnosed with scurvy. Data collected from electronic medical records included baseline characteristics, clinical features on presentation, bloodwork results from initial consultation, treatment plan as well as response to treatment. FindingsTwenty-two adults patient had a diagnosis of scurvy with a mean vitamin C level of 6 μmol/L. Iron deficiency anemia (54%) and gastrointestinal disorders (54%) were the most common comorbidities noted in our cohort. Proton-pump inhibitors use was noted in 54% of patients. Bleeding (45%) and bruising (45%) were the most commonly reported clinical features. Eleven patients received oral supplementation, five had intravenous (IV) vitamin C and six were not treated. Two patients required a transition from oral to IV supplementation. Vitamin C dosing ranged between 250 and 2000 mg and the frequency varied from daily for oral therapy to every few weeks or months for IV. InterpretationAwareness of scurvy and its associated risk factors and clinical presentation is important in the evaluation of a patient with bleeding tendency. Treatment plan should be individualized, and a careful review of patients' diet, medial history and medications is warranted.

Scurvy mimicking juvenile idiopathic arthritis in two pediatric patients

Scurvy, though previously reported from developing countries, is now being increasingly reported from developed countries. Although rare in pediatric population, it is well known to cause lower-extremity pain and refusal to walk in children. Here, we summarize two cases of scurvy in young children who presented with difficulty to walk. Both of them came with a provisional diagnosis of oligoarticular juvenile idiopathic arthritis. The first case underwent extensive evaluation before the diagnosis of scurvy was made. Dietary histories eventually revealed that both had limited intake of fruits and vegetables, as first patient existed on a diet of milk products and a nutritional supplement provided by the state government. The second patient had autism. Radiographic changes of long bones were observed in both patients. Both of them had a Vitamin C level of

Scurvy: A Case Report on a Child With Autism

Scurvy is a nutritional deficiency which has currently become uncommon. Accurate history taking, strong suspicion and good clinical correlation especially in high risk groups are important in making an early diagnosis. A 9-year-old boy with underlying autism was presented to the Pediatric Dental Clinic with gingival swelling, fever and refusal to walk. The child was subsequently referred to the Pediatric Medical team for suspicion of a hematological malignancy. After a thorough assessment, he was diagnosed of having scurvy due to his peculiar diet habit. Vitamin C supplementation was started as diagnostic and therapeutic measures. Scurvy is a disease caused by chronic vitamin C deficiency. Though it has become uncommon, it still exists in high risk populations. The clinical manifestation of scurvy could be variable and non-specific. In practice, the diagnosis of scurvy is based on history and clinical findings. In cases of suspicion, resolution of disease manifestations after vitamin C supplementation remains the best diagnostic evidence. High index of suspicion is crucial to diagnose scurvy early in modern era. Early diagnosis is important for prompt initiation of treatment and fast resolution of symptoms. Int J Clin Pediatr. 2018;7(4):59-62 doi: https://doi.org/10.14740/ijcp321

Scurvy in the Postoperative Oropharyngeal Cancer Patient

Scurvy is now an almost forgotten disease, but it hasn’t yet disappeared entirely. Here, we report the case of a patient with scurvy who presented with multiple hemorrhages about 5 years after undergoing pharyngeal surgery and radiochemotherapy for oropharyngeal cancer. This 60-year-old man was admitted to our hospital because of sudden onset of dyspnea and purpura. A physical examination and computed tomography revealed multifocal hemorrhages, namely, purpuras and petechiae on the legs and intramuscular and alveolar hemorrhages. Coagulation tests indicated a normal bleeding time and mild extension of the activated partial thromboplastin time. The coagulation factor activities were not low enough to account for such severe hemorrhages. No new hemorrhages were observed after admission. On questioning about his past eating habits, the patient reported having long had an extremely unbalanced diet, namely, a diet that was composed largely of carbohydrates with few fresh fruits and vegetables. This was due to the development of mechanical dysphagia after the operation. Since his vitamin C level was 0.5 μg/mL (normal range: 5.5 - 16.8 μg/mL), a diagnosis of scurvy was established. Thus, scurvy can still occur in modern times due to poor eating habits that arise from unusual settings. We must keep in mind that scurvy may be the cause when a patient presents with an apparently inexplicable tendency to hemorrhage.