Scurvy is a rare disorder, with epidemics typically affecting populations subject to famine or displacement during wartime.
Most key clinical manifestations are related to impaired collagen synthesis. These include bleeding complications (spontaneous petechiae and ecchymoses), friable gingiva and loose teeth, bone pain, and joint effusions.
Other complications include heart failure, encephalopathy, and entrapment neuropathies.
If not treated promptly, scurvy can be fatal.
Complete recovery is anticipated in most patients.
Scurvy is a life-threatening condition due to dietary vitamin C deficiency. Those affected are mostly refugees or victims of famine, older people, individuals with a history of alcohol misuse or an atypical diet, or children with autism or idiosyncratic behavioural abnormalities. Cardinal features include spontaneous bleeding from gums or poor wound healing, perifollicular ecchymoses, haemarthroses, and joint pain. Diagnosis is often delayed because of slow identification of disease or incomplete review of dietary history. Rapid resolution occurs after vitamin C treatment.
History and exam
- 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
- conjunctival and subconjunctival haemorrhage
- famine and refugee populations
- older people
- living alone
- psychiatric disorders
- alcohol use disorder
- low income
- atypical diets
- 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
- critical illness
- acute respiratory distress syndrome
- graft versus host disease (GVHD)
James M. Noble, MD, MS, CPH
Associate Professor of Neurology
Columbia University Irving Medical Center
Department of Neurology
Taub Institute for Research on Alzheimer’s Disease and the Aging Brain
G.H. Sergievsky Center
JMN is an author of two articles cited in this topic.
Marc C. Patterson, MD
Division of Child and Adolescent Neurology
Professor of Neurology, Pediatrics, and Medical Genetics
Child Neurology Training Program
MCP is a member of the scientific advisory boards of the Ara Parseghian Medical Research Foundation, the National Niemann-Pick Disease Foundation, and the Metachromatic Leukodystrophy Foundation. MCP has been a consultant for Actelion, Amicus, IntraBio, Novartis, Orphazyme, Shire, and Vtesse. MCP has undertaken contractual research for Cerecor, Glycomine, Idorsia, and Shire. MCP has stock in IntraBio. MCP has received travel, accommodation or meeting expenses from Actelion, Amicus, Novartis, and Orphazyme.
Sebastian Padayatty, MRCP, PhD
Molecular and Clinical Nutrition Section
Digestive Diseases Branch
National Institute of Diabetes and Digestive and Kidney Diseases
SP declares that he has no competing interests.
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