Dr.Shari Lipner at Weill Cornell Dermatology, York Avenue, New York, USA has reported a classic case of Scurvy that has appeared in the Lancet. Vitamin C deficiency may be common in third-world countries due to malnutrition, but it is currently rare in developed countries like the U.S.A.
As the history goes, a 40-year-old woman with a history of chronic pancreatitis and gastro-oesophageal reflux disease presented with fatigue, malaise, dizziness, difficulty ambulating, diarrhoea, easy bruising, and a diffuse rash involving her extremities and trunk that had been present for several days.
She explained that she had limited her diet to consist mostly of bread, rice, dumplings, and the occasional egg white to reduce the symptoms she suffered from her gastro-oesophageal reflux disease. Her diet was also devoid of red meat, fish, chicken, fruits, and vegetables.
On physical examination, she had extensive, non-palpable, perifollicular haemorrhages involving her extremities (figure), ecchymosis (figure), and gingival bleeding. Corkscrew hairs, visible with the unaided eye, were seen all over her skin-although they were much more apparent with dermoscopy.
Her laboratory results revealed haemoglobin 8·3 mg/dL, haematocrit 25·2%, and a plasma vitamin C concentration of <5 μmol/L (normal range 23–50 μmol/L). Endoscopy of the upper gastrointestinal tract and colonoscopy of the lower bowel did not find a source of bleeding.
A biopsy of the skin from her right lower leg demonstrated a corkscrew-shaped profile of the hair follicle, and histopathological examination showed follicular hyperkeratosis and plugging (figure). Taken together, the clinical, laboratory, and histopathological findings were consistent with a diagnosis of scurvy.
The patient was given intravenous vitamin C followed by daily oral supplementation and her symptoms resolved within a few weeks.Early diagnosis and treatment of scurvy can be life-saving, so recognition of the physical findings is important.
Vitamin C must be obtained from dietary sources and it is essential for hydroxylation of proline and lysine residues for the synthesis of collagen. It is also important for immune system function and iron absorption. Scurvy rarely affects adults but may be seen in some individuals with malnutrition or malabsorption. Signs and symptoms usually occur by the third month of inadequate consumption, and treatment is with vitamin C supplementation.
In order to prevent Scurvy what should be the normal intake of vitamin C?
- babies need around 25mg of vitamin C a day
- children 1-10 years old need around 30mg
- children 11-14 years old need around 35mg
- older children and adults need around 40mg (and more for those who smoke or drink large amounts of alcohol)
- pregnant women need 50mg of vitamin C a day
- breastfeeding mothers need around 70-75mg
Source: NHS Choices
Dr. Kamal Kant Kohli
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