Revisiting the pathobiology of scurvy: a review of the literature in the context of a challenging case

Abstract

Scurvy is a nutritional disorder resulting from vitamin C deficiency. Although rare in developing countries, scurvy continues to develop in settings of limited dietary intake such as post-gastrointestinal surgery and restrictive dietary habits. The disease primarily affects the skin and soft tissue. As the state of deficiency persists, hematological and immunological sequelae may develop. The classic signs of scurvy are not always present and can be altered by the presence of other comorbidities. In this article, we present a challenging case of scurvy in an older male from an urban tertiary healthcare setting. We review the atypical and uncommon clinical and pathological findings of scurvy including those seen in the skin, blood, and bone marrow. We also review contemporary research findings that provide a better understanding of the pathogenicity and clinical manifestations of vitamin C deficiency.

Factors Affecting Vitamin C Status and Prevalence of Deficiency: A Global Health Perspective

“…Even mild insufficiency or hypovitaminosis C can be associated with symptoms such as low mood [10]. More severe deficiency can be associated with a range of clinical presentations [11]. Prolonged severe deficiency results in the clinical syndrome of scurvy, a condition that continues to be diagnosed in individuals and occasionally in public health outbreaks to this day [12]; if left untreated, scurvy is a fatal disease.…”

Co-occurring features of scurvy and phrynoderma in the same patient

“…Scurvy is a nutritional disorder resulting from a sustained and severe vitamin C deficiency. 1 Vitamin C, or ascorbic acid, is a water-soluble molecule that is absorbed in the small intestine. 1 It is a cofactor in 15 enzyme pathways, playing a crucial role in the conversion of procollagen into structurally normal collagen.…”

“… 1 Vitamin C, or ascorbic acid, is a water-soluble molecule that is absorbed in the small intestine. 1 It is a cofactor in 15 enzyme pathways, playing a crucial role in the conversion of procollagen into structurally normal collagen. For this reason, its deficiency results in capillary and tissue fragility, leading to hemorrhage.…”

“… 2 , 3 In addition to its contribution to the maintenance of soft tissue structure, vitamin C is important for immune regulation, immunity against infections, and hematopoiesis. 1 Humans cannot synthesize ascorbic acid. The main dietary sources of ascorbic acid are vegetables and fruits; there are minimal amounts in meat and milk.…”

“… 2 These findings are correlated with skin biopsy results showing thickened stratum corneum and extravasated red blood cells in the upper dermis and around the hair follicles and other adnexal structures. 1 The gums may become friable, with swelling and bleeding. 2 Poor wound healing and blood vessel fragility manifesting with petechiae and ecchymoses can also be seen.…”