Last reviewed: November 2017
Last updated: July  2016

Summary

Definition

History and exam

Key diagnostic factors

  • vitamin C deficiency upon dietary review
  • constitutional symptoms
  • easy bruising or bleeding
  • gait impairment or leg pain
  • pedal oedema
  • petechial and perifollicular haemorrhages (legs and feet)
  • poor wound healing
  • bruising and nodular or black ecchymoses at non-traumatic sites
  • joint swelling
  • oral mucosal petechiae
  • coiled hairs
  • follicular hyperkeratosis
  • tooth loss
  • gingival discoloration
  • gum swelling
  • lid petechiae and haemorrhages
  • proptosis
  • conjunctival and subconjunctival haemorrhage

Other diagnostic factors

  • dysphagia
  • alopecia
  • sicca-like or Sjogren's-like syndrome
  • nail clubbing
  • peripheral (entrapment) neuropathy
  • CVA
  • CHF
  • haemorrhagic pleural effusion
  • osteoporosis

Risk factors

  • famine and refugee populations
  • older people
  • living alone
  • psychiatric disorders
  • alcoholism
  • dementia
  • low income
  • faddist diet
  • poor dentition or masticatory inefficiency
  • autistic spectrum disorder
  • static encephalopathies of childhood
  • infants taking only cow's milk
  • end stage renal disease and/or haemodialysis dependence
  • smoking
  • surgery
  • sepsis
  • HIV
  • critical illness
  • ARDS
  • pancreatitis
  • graft versus host disease (GVHD)

Diagnostic investigations

1st investigations to order

  • FBC and peripheral blood smear
  • serum ascorbic acid
  • leukocyte ascorbic acid
  • whole blood ascorbic acid
  • x-ray of knee and wrist
Full details

Investigations to consider

  • MRI of knee, wrists, and long bones in paediatric cases
  • bone marrow biopsy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

James M. Noble

Assistant Professor of Clinical Neurology

Neurology Clerkship Director

Department of Neurology

Harlem Hospital Center

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

JMN declares that he has no competing interests.

Marc C. Patterson

Chair

Division of Child and Adolescent Neurology

Professor of Neurology, Pediatrics, and Medical Genetics

Director

Child Neurology Training Program

Mayo Clinic

Rochester

MN

Disclosures

MCP declares that he has received consultancy fees from Actelion, Alexion, Agios, Novartis, Orphazyme, Shire, and Vtesse; travel and accommodation expenses from Actelion, Alexion, Agios, and Shire; a grant from Actelion; honoraria from Journal of Child Neurology/Child Neurology Open and Journal of Inherited Metabolic Disease; and royalties from Up-to-Date.

Peer reviewers VIEW ALL

Endocrinologist

Molecular and Clinical Nutrition Section

Digestive Diseases Branch

National Institute of Diabetes and Digestive and Kidney Diseases

Bethesda

MD

Disclosures

SP declares that he has no competing interests.

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