Scurvy: Rare Orthopaedic Complications Associated with Multinutritional Deficiencies

Abstract

Suboptimal nutrition can lead to deficiencies in micronutrients such as ascorbic acid (vitamin C), which can present with catastrophic neurological sequelae. Deficiencies of vitamin C, vitamin B3 (niacin) and zinc levels contribute to reduced bone density. Vitamin C associated vertebral fractures, although rare in adults, are still treatable if diagnosed early with a thorough clinical and nutritional history, and early supplementation. Radiological clues suggestive of scurvy-induced vertebral fractures can be diagnosed on plain X-ray and MRI spine imaging.

Learning points: Although nutritional deficits like scurvy, pellagra and zinc deficiency are rare, early recognition and prompt treatment can prevent critical neurological sequelae.Clinical history including nutritional intake and associated patient symptoms are vital to diagnose scurvy-related vertebral fractures, which are treatable.It is important to note that scurvy can also present in an adult population.

Keywords: Scurvy; micronutrient; niacin; nutrition; vertebral fractures; vitamin C; zinc.

Figure 1

Clinical photographs demonstrating purpuric lesions on upper extremities (A) and bilateral lower extremities with haemorrhagic confluence at right ankle (B).

Figure 2:

Sagittal MRI spine in T2(A), T1(B), STIR (C) sequences. Illustrates acute T11 burst fracture with almost complete loss of the vertebral body height. Retropulsed segment of bone causing indenting of the cord but no signs of cord injury. Posterior ligamentous complex intact.