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
- cerebrovascular accident
- cardiac failure
- haemorrhagic pleural effusion
- osteoporosis
Risk factors
- famine and refugee populations
- older people
- living alone
- psychiatric disorders
- alcohol use disorder
- dementia
- 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
- smoking
- surgery
- sepsis
- HIV
- critical illness
- acute respiratory distress syndrome
- 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
Investigations to consider
- MRI of knee, wrists, and long bones in paediatric cases
- bone marrow biopsy
Treatment algorithm
high risk or symptomatic population
Contributors
Authors
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
Columbia University
New York
NY
Disclosures
JMN is an author of two articles cited in this topic.
Marc C. Patterson, MD

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 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.
Peer reviewers
Sebastian Padayatty, MRCP, PhD
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.
Differentials
- Systemic vasculitis
- Haematological malignancy
- Meningococcaemia
More DifferentialsGuidelines
- Nutrient reference values for Australia and New Zealand including recommended dietary intakes
- Dietary reference intake for vitamin C
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