Latent scurvy with tiredness and leg pain in alcoholics: An underestimated disease three case reports

Abstract

Rationale: Scurvy is often diagnosed at the state of well-established signs as, for example, skin and visceral purpura, gums involvement, loss of healthy teeth, which derive mostly from disturbance of collagen metabolism. Little is known about the state of latent scurvy, which symptoms are nonspecific and may mimic more common conditions such as weakness, leg pain, and muscle aching.

Patient concerns: We report 3 cases of extreme lassitude and leg pain in alcoholics. In 2 of the 3 cases, discreet classic symptoms such as petechiae or hyperkeratosis of the legs involving collagen metabolism were also present.

Diagnoses: Latent scurvy has been diagnosed thanks to historical experimental data reporting and undetectable ascorbic acid levels.

Interventions: In addition to the treatments recommended by the French Alcohol Society, patients were given oral vitamin C 500 mg to 1000 mg per day for at least three months.

Outcomes: Vitamin C supplementation allowed the regression of the symptoms, greatly improved the quality of life, and gave the possibility to return to work. Cartinine, requiring vitamin C for its hydroxylation, is an essential cofactor in the transport of long-chain fatty acid into mitochondrial matrix. Therefore, it plays an important role in energy production via beta-oxidation. It is thought that carnitine metabolism impairment is responsible for weakness or muscle aching.

Lessons: We recommend being aware of the possibility of latent scurvy in chronic alcohol abusers. The vitamin C supplementation and dietetic recommendation eating fresh fruit and vegetables may help to cure tiredness and to return more easily to socialization and to work.

Figure 1

Case report no. 3; Large lesions of prurigo due to intercurrent scabiose.

Figure 2

Case report no. 3; Hyperkeratosis of the inner part of the feet. Follicular keratosis can be seen on the shin.