Scurvy in 2017 in the USA

Abstract

Vitamin C deficiency may be common in third-world countries due to malnutrition, but it is currently rare in the USA. Initially, nonspecific symptoms like exhaustion and depression may make this disease difficult to diagnose until classical dermatological manifestations appear. Diagnosis mainly relies on clinical presentation, dietary history to identify risk factors, and dramatic recession of symptoms and signs following vitamin C therapy. Human beings cannot synthesize vitamin C and hence need 90% of vitamin C intake from fruits and vegetables. As a processed carbohydrate-rich diet becomes the staple food, scurvy must be recognized before it becomes potentially fatal. We describe a 65-year-old man with dyspnea, fatigue, anemia, and bleeding diathesis from scurvy and emphasize the importance of dietary history and the critical role of vitamin C in diagnosis and management of this forgotten entity.

Scurvy: A Rare Cause of Anemia

“…The initial symptoms of scurvy patients can vary depending on the context of the patient’s situation. Some patients may present with more extreme symptoms, such as hemorrhagic diathesis, although many patients show initial symptoms of anemia, perifollicular hemorrhages, bruising, and pain in upper and lower extremities, as presented in this case [8-9].…”

“…After a few months of supplementation, patients’ vitamin levels are typically in accordance with the recommended dietary allowance (RDA). Commonly targeted in many scurvy cases, vitamin C therapy is used to replete the body with a proper dietary plan and vitamin C supplements [8-9].…”

Hair, Nails, and Skin: Differentiating Cutaneous Manifestations of Micronutrient Deficiency

“…Replenishment of vitamin C deficiency may require up to 300 mg daily in pediatrics and up to 1000 mg daily for adults . Vitamin C doses of 300 mg daily for 1 month should be sufficient replenishment to decrease symptoms and for 3 months for a full recovery from scurvy . An alternative supplementation regimen for adults includes 2 g daily for 3 days followed by 500 mg daily for a week then 100 mg daily for up to 3 months .…”

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

“…The third national health and nutrition examination survey in the US, conducted from 1988 to 1994, estimated that approximately 13% of the population were vitamin C deficient. 4 A 2012-2013 national screening in Canada found that less than 3% of the population is deficient. 5 Finally, a recent national Dutch nutritional survey found that adults with low micronutrient intake had the highest risk of vitamin B6 deficiency, followed by vitamin C deficiency.…”

“…Inadequate intake and deficiency of vitamin C can occur in the setting of a limited diet, creating a population at higher risk of progressing to scurvy. The third national health and nutrition examination survey in the US, conducted from 1988 to 1994, estimated that approximately 13% of the population were vitamin C deficient 4 . A 2012–2013 national screening in Canada found that less than 3% of the population is deficient 5 .…”