Diagnosis Of Scurvy Research Articles

Brief Report: Scurvy as a Manifestation of Food Selectivity in Children with Autism.

Scurvy was diagnosed in seven children at Boston Children's Hospital. All of the children had a developmental disorder and autism was the most common. They had a long-standing history of food selectivity with diets devoid of fruits and vegetables, and none of the children were supplemented with a multivitamin. They presented with limp, and an elaborate panel of tests and procedures were undertaken before the diagnosis of scurvy was made. Treatment with vitamin C led to rapid recovery of symptoms. This report emphasizes the importance of considering nutritional causes of musculoskeletal symptoms in children with autism and restrictive diets.

Anorexia Nervosa and Scurvy - a Case Report

Introduction Eating disorders with cutaneous manifestations are common, but scurvy is an extremely rare complication of anorexia nervosa. Human body is not able to produce vitamin C, so he must obtain it from dietary intake. Clinical manifestations occur after vitamin C has been eliminated from the diet for 2-3 months and when the body pool is below 350 mg. Objectives To report a clinical case of scurvy in a female patient with restricting type of anorexia nervosa and emphasize the risk of poor vitamin C intake in developing a disease that might have a fatal outcome. Methods Case report and systematic review of literature. Case Report We report a clinical case of a 21 year-old woman with restricting type of anorexia nervosa, who developed ecchymosis and petechiae on the torso and legs, pedal edema, anemia normocytic normochromic and symptoms such as fatigue, weakness. The diagnosis of scurvy is usually based on clinical findings and dietary history, with therapeutic evidence as soon as vitamin C supplementation begins. After two weeks of treatment the cutaneous signs fully disappeared. Results When scurvy is diagnosed early, the condition can be readily treated, so we should be aware of this disease in anorexia nervosa, so that we can intervene quickly and ameliorate the clinical status. Conclusions Although scurvy is regarded by many as a disease from the past we should be conscious of its existence in developed countries as a nutritional consequence of poor intake in anorexia nervosa.

Classic Skin Findings of Scurvy

Department of Medical Education, Gundersen Medical Foundation (D.D.F.), and Infectious Disease Section, Department of Internal Medicine, Gundersen Health System (T.J.K.), La Crosse, WI. A 43-year-old man with a long history of alcohol abuse presented with altered mental status, confabulation, and rash. He had perifollicular, hyperkeratotic papules and corkscrew hairs over his forearms, thighs, and upper abdomen (Figures 1 and 2), as well as gingival bleeding. A skin biopsy specimen revealed perifollicular fibrosis associated with perifollicular hemorrhage (Figure 3) consistent with a diagnosis of scurvy. The patient was treated with 500 mg of ascorbic acid daily, and the rash resolved after 1 week of treatment. His neurologic symptoms were subsequently determined to stem from Wernicke encephalopathy, which was caused by a coexistent thiamine deficiency.

Analysis of nutritional disease in prehistory: The search for scurvy in antiquity and today

In this paper, we discuss the issues surrounding the study of scurvy, or vitamin C deficiency, in paleopathology, and highlight the work of Donald Ortner in advancing this area of research. This micronutrient deficiency impacts collagen formation and results in damage to a variety of bodily tissues. While clinical manifestations are observed routinely, the lack of specific signatures on bone makes paleopathological diagnosis difficult. Rapid growth in infants, children, and subadults provides abundant remodeled tissue and an increase in vascularization that makes identification possible in younger segments of the population. However, diagnosis of scurvy in adults remains problematic, given that diagnostic lesions are strikingly similar to those associated with rickets, osteomalacia, and other conditions. We argue that this confounding factor underscores the need for a broader anthropological approach to scurvy research that expands beyond differential diagnosis to include more accurate reconstruction of diets and available resources, greater consideration of the possibility – even likelihood – of multiple nutrient deficiencies simultaneously affecting an individual, and the patterning of these deficiencies along lines of status, sex, and age.

Nutrition-related health problems in a wealthy 17–18th century German community in Jelgava, Latvia

The aim of this research is to assess the presence of stress in a high status German population from Jelgava, Latvia. The skeletal material used in this study came from a recently excavated church cemetery, with most of the burials dating to the 17–18th centuries. In total, 108 individuals (80 adults and 28 non-adults) were analysed for evidence of scurvy, rickets/osteomalacia and anaemia. The presence of scurvy and healed rickets/osteomalacia could not be confirmed in any adult individual. Among non-adults, a possible diagnosis of scurvy was considered in six individuals, and active rickets was suggested in two others. Cribra orbitalia in adult and non-adult individuals also argued for the presence of childhood stress. These results, combined with previously acquired data on linear enamel hypoplasia, indicated that children in this population suffered from nutritional deficiencies. The presence of childhood stress markers in adult individuals implies that many children survived stress episodes, possibly due to generally good access to resources, as supported by historical accounts and previous studies on stature and dental disease.

Skeletal Manifestations of Scurvy: A Case Report from Dubai

Introduction. Nutritional deficiencies are rarely reported in developed countries. We report a child of Pakistani origin brought up in Dubai who developed skeletal manifestations of scurvy due to peculiar dietary habits. Case Presentation. A 4.5 year old boy presented with pain and swelling of multiple joints for three months and inability to walk for two months. Dietary history was significant for exclusive meat intake for the preceding two years. On examination the child's height and weight were below the 5th percentile for his age. He was pale and tachycardic. There was significant swelling and tenderness over the wrist, knee and ankle joints, along with painful restriction of motion. Basic blood workup was unremarkable except for anemia. However, X-rays showed delayed bone age, severe osteopenia of the long bones, epiphyseal separation, cortical thinning and dense zone of provisional calcification, suggesting a radiological diagnosis of scurvy. The child was started on vitamin C replacement therapy. Over the following two months, the pain and swelling substantially reduced and the child became able to walk. Repeat X-rays showed improvement in the bony abnormalities. Conclusion. Although scurvy is not a very commonly encountered entity in the modern era, inappropriate dietary intake can lead to skeletal abnormalities which may be confused with rickets. A high index of suspicion is thus required for prompt diagnosis of scurvy in patients with bone and joint symptoms.

Inability to walk due to scurvy: a forgotten disease

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.

Scurvy in child with epilepsy on a ketogenic diet with oral complications

Epilepsy is a symptom of cerebral dysfunction, where there is a sudden and disorganised discharge of electrical activity from a group of neurones, producing symptoms that range from sensory absences to convulsive movements and unconsciousness. Fasting is recognised as reducing the frequency of epileptic seizures in difficult to control patients. The ketogenic diet is a high fat, low carbohydrate and adequate protein diet that mimics the biochemical effects of fasting. It is deficient in some essential elements that require supplementation. A 9-year old girl with learning difficulties, developmental delay and refractory epilepsy was placed on the ketogenic diet in 2003. Prior to starting the diet she had had as many as 12 tonic seizures/day, with prolonged periods of non-convulsive status epilepticus. Subsequent to being placed on the diet, the frequency of her seizures reduced markedly; there were long periods during which she had none. In late 2006, the patient inhaled a primary molar. This was retrieved by emergency bronchoscopy and at the same time the remaining primary teeth were extracted. Three weeks later she was admitted to hospital with low-grade fever, persistently bleeding sockets, oedema of her hands and feet, a petechial rash and bruising. A differential diagnosis included: liver disease, bleeding dyscrasia, oncological pathology or scurvy. The most striking finding amongst a number of investigations was a vitamin C level of 0.7 micromol/l (Deficiency: < 11 micromol/l). Accordingly a diagnosis of scurvy was made. The patient was prescribed ascorbic acid 500 mg twice/day. Three weeks later the patient's vitamin C level was 141.5 micromol/l; the dose was therefore reduced to 250 mg once/day. At two-month review, the signs and symptoms of scurvy had resolved. Inhaling a tooth and scurvy are both rare occurrences. Paediatric dentists should be aware of the possible implications of a ketogenic diet.

Gingival hypertrophy: a solitary manifestation of scurvy

A 48-year-old woman presented with rapid onset hypertrophy of both the upper and lower gingiva. A detailed history and a diet nearly void of fruits and vegetables raised the suspicion of a possible deficiency of vitamin C. An estimation of the serum ascorbic acid level confirmed our suspicions (<0.12 mg/dL; normal range, 0.4–1.0 mg/dL) and a diagnosis of scurvy was confirmed. A course of 1000 mg/d of ascorbic acid was initiated that caused a dramatic resolution of the gingival lesions. Gingival hypertrophy has a large differential diagnosis; however, it is also known to be an extremely rare manifestation of scurvy. A high index of suspicion for scurvy is relevant given its low prevalence in developed nations and how easily remediable the disease can be, even when it presents in a severe form.

Escorbuto: púrpura folicular como signo guía

Scurvy is a set of clinical manifestations characterized by general weakness, anemia, gingivitis and cutaneous bleeding, caused by a lack of ascorbic acid in the diet. This pathology is currently a clinical rarity, although it can still be seen in cases of malnutrition associated with alcoholism or with dietary deficiencies, especially in childhood and old age. We present the case of a 45-year-old male who consulted his physician because of lower limb edema with follicular purpura, accompanied by asthenia, polyarthralgia and bleeding gums. After treatment with 1 g/day of vitamin C was initiated, the patient's symptoms quickly improved. The diagnosis of scurvy was based on the patient's clinical symptoms, dietary history and the rapid resolution of the symptoms when vitamin C supplements were initiated.

The mystery of the wooden leg: vitamin C deficiency in East African prisons

Vitamin C deficiency (scurvy) is an uncommon disease in modern times, and therefore easily misdiagnosed when it appears. While visiting prisoners in East Africa, health delegates of the International Committee of the Red Cross (ICRC) encountered prisoners suffering from a hitherto undiagnosed 'mysterious' illness, consisting mainly of swollen and hard legs, that had not responded to various treatments given by the local health centre or hospital. The ICRC set out to investigate the nature of this disease and examined 133 prisoners with the suspected clinical symptoms described as 'wooden leg' syndrome in 10 different prisons. Serum ascorbic acid levels were measured and a food basket analysis done. The diagnosis of scurvy was confirmed. All patients responded to standard treatment with oral ascorbic acid. The clinical presentation of scurvy in these East African prisons seems to be somewhat different from the classic descriptions, but is in line with historic records of the disease. Treatment is easy and cheap, and response to treatment is quick. Scurvy remains a problem in prisons in Africa and clinicians working in prisons need to be aware of its presence and its presentations.

Scurvy Presenting as Painful Gait With Bruising in a Young Boy

A case of scurvy occurred in an apparently well-nourished 5-year-old boy with normal growth parameters. Only after the diagnosis of scurvy was raised on clinical grounds did we discover the peculiar dietary habits that were responsible for his deficiency of ascorbic acid. His case is a reminder to the clinician that nutritionally based disease may occur in any socioeconomic setting and that nutritional screening remains an important part of every child's general health care.

FOLLOW UP A CASE REPORT OF IATROGENIC SCURVY IN AN INDUSTRIALIZED SOCIETY

104 Nutritional deficiency of ascorbic acid (scurvy) is very uncommon, and likely to occur only in individuals with an extremely unusual diet. We report a case of a child presenting with scurvy following tube feedings of Neocate One Plus for approximately one year. The Patient is now a 3 year old boy who required gastrostomy tube feedings at one month of age because of dysphagia and poor intake. At 8 months of age the patient required a nissen fundoplication due to constant vomiting. Following Nissen fundoplication the patient presented with retching, gagging and irritability. Multiple changes were made in the enteral formula. The formula was changed to Neocate One Plus, and the symptoms diminished. Six months later, the patient developed gum bleeding and required oral surgery, and was also admitted for presumed osteomyelitis. Subsequently the patient had multiple admissions for recurrent osteomyelitis. One year later, the patient was re-admitted again for presumed osteomyelitis and a course of antibiotics. An x-ray of the shoulder revealed a fracture. At this point, clinical and radiological studies were reassessed and a diagnosis of scurvy was suspected. Vitamin C level was found to be 0. Neocate One Plus contains less vitamins as well as minerals in comparison to other elemental formulas. The enteral formula was providing 28 mg of Vitamin C, 50% of the RDA. Nutritional deficiencies were not part of the differential diagnosis during previous admissions due to the fact that the patient had demonstrated good weight gain and growth. After receiving vitamin C supplementation patient showed improvement clinically and radiologically. It is well accepted that caloric requirements are less in neurologically impaired patients, lending to restriction of the enteral formula volume to help control calories. These patients need close monitoring and consideration should be given to provide vitamin and mineral supplements.

Scurvy

Scurvy is caused by a deficiency of ascorbic acid. We describe a 31-year-old Hispanic man who had perifollicular hemorrhages, follicular hyperkeratosis, corkscrew hairs, and gingival hemorrhage after consuming a peculiar and restricted diet for 1 year. A diagnosis of scurvy was made and the patient's disease resolved after treatment with vitamin C.

Scurvy

• A 9-year-old girl had the insidious development of lethargy, gingival erosions, and follicular hyperkeratosis with perifollicular hemorrhage. A dietary history disclosed that she consumed only one kind of sandwich and beverage and took no other foods. A skin biopsy specimen was consistent with the diagnosis of scurvy, and marked improvement occurred with ascorbic acid therapy. Although it is an uncommon disorder in the United States, scurvy may occur in persons with prolonged and peculiar dietary habits. (<i>Arch Dermatol</i>1984;120:1212-1214)

Risk Of Scurvy And Osteomalacia In Elderly Long-Stay Psychiatric Patients

SummaryFollowing a diagnosis of scurvy amongst elderly long-stay psychiatric patients,a 6-d weighed food survey was carried out on a random sample of 14 patients.Blood was taken for biochemical and...

Hypovitaminosis C and splenic rupture.

Two cases of splenic rupture in patients with hypovitaminosis C are reported. In Case 1 the deficiency was dietary in origin; this patient also had pernicious anaemia with an associated thrombocytopenia. These 2 abnormalities are considered significant in predisposing to splenic rupture on minimal trauma. In Case 2, in which the vitamin C deficiency was due to dietary deficiency and to malabsorption following partial gastrectomy, the low leucocyte ascorbic acid was the only abnormality detected, and the splenic rupture was spontaneous. A splenectomy was carried out and at operation there was noted to be persistent oozing of blood from muscle and subcutaneous tissue, and post-operatively, from the wound. It is suggested that in cases of spontaneous rupture of the spleen, as in any case of unexplained haemorrhage, the diagnosis of scurvy should be considered.

Vitamin C.

<h3>DIETARY PRACTICES AND SCURVY</h3> The principle of preventing scurvy by the use of certain foods had to be learned repeatedly in early human experience. Primitive peoples seldom had a choice of orange juice, grapefruit, tomato juice, cantaloupe or strawberries for breakfast, but nearly all tribal groups knew that fresh foods were necessary for their health and survival. Practices varied from eating thistle tops in the Gobi Desert area to consuming water extracts of evergreen leaves in forested sections of North America, Europe and Asia. Scurvy, in the classic sense,¹is no longer a major disease, but severe cases are encountered occasionally in nearly all medical centers, and many mild cases remain undetected or are confused with mild cases of rickets. There is good evidence that moderate deficiencies impair health without giving rise to the classic signs that result in a diagnosis of scurvy. Therefore, a reliable intake of vitamin

HEMOCHROMATOSIS AND PURPURA

1description in 1871 of a case of ``diab\l=e'\tesucr\l=e'\'' with pigmentary changes, approximately 175 cases of hemochromatosis have been reported. Fourteen, or 9 per cent, of the 153 cases from the literature with data available for study, exhibited some degree of purpura, while in an additional 9 cases, or 6 per cent, hemorrhagic manifestations other than purpura developed in the course of the disease. Other authors have discussed this occurrence and have speculated on its importance in the etiology of the pigment deposits that are characteristic of the disease. In spite of this incidence of purpura in hemochromatosis, it is not generally mentioned as a frequent symptom. The necropsy records of the department of pathology of the New Haven Hospital between 1917 and 1930 contain reports of 5 cases of hemochromatosis, all of which occurred in males. Two of the patients, at the time of admission, had purpura of such striking degree as to suggest the diagnosis of scurvy. In an earlier case reported from this hospital by Blumer,2 a petechial eruption developed on the arms and legs a few hours before death. In this report, the clinical course and pathologic observations in the two more recent cases are presented, together with a discussion of the possible explanations for purpura in hemochromatosis.

A CRITERION OF HEMORRHAGIC DIATHESIS IN EXPERIMENTAL SCURVY

1. The degree of scorbutic change in the vessels of animals with experimental scurvy can be roughly measured by establishing the amount of negative pressure required to produce petechial hemorrhages in the skin. 2. The test shows that the hemorrhagic diathesis in experimental scurvy develops earlier than any other known sign of the disease and that it persists in some degree throughout. 3. The response of the blood vessels to the administration of antiscorbutic substances is extremely rapid as shown by the test, but it varies with the amount of antiscorbutic given and its method of administration. 4. The changes in the resistance of the vessels follows a curve which rises towards recovery during the end of the 1st week on a scorbutic diet, reaches a peak in the 2nd week and then falls steadily during the remainder of the course of the disease. This indicates that the course of the disease is not constant and progressive. 5. The test may have clinical value in the diagnosis of scurvy.