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.

Keywords: Bleeding diathesis; collagen defects; scurvy; vitamin C.

Figure 1.

Right arrow showing perifollicular hemorrhages and left arrow showing extensive ecchymosis.

Figure 2.

(a) Extensive ecchymosis of the lower extremity prior to the treatment. (b) Resolution of ecchymosis after vitamin C treatment.