<i>Sailing the ship of life: scurvy and autoimmunity . . .</i>

Essien, Francis; Jacocks, Charles; Carroll, Matthew

doi:10.1177/20406223221078080

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Scurvy displays a wide spectrum of visible and radiologic findings that are helpful in diagnosis. Humans lack the capacity to synthesize ascorbic acid, but the organic substance is essential to the human diet due to its role as a cofactor to many metabolic processes, the most important being collagen synthesis [ 2 , 7 , 12 ]. Early manifestations of severe vitamin C deficiency include fatigue, decreased exercise tolerance, and depression [ 2 , 4 , 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Humans lack the capacity to synthesize ascorbic acid, but the organic substance is essential to the human diet due to its role as a cofactor to many metabolic processes, the most important being collagen synthesis [ 2 , 7 , 12 ]. Early manifestations of severe vitamin C deficiency include fatigue, decreased exercise tolerance, and depression [ 2 , 4 , 7 , 9 ]. The most distinguishing features of scurvy are cutaneous findings including follicular hyperkeratosis, perifollicular hemorrhages, ecchymoses, leg edema, and poor wound healing [ 2 , 4 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Complete resolution of symptoms is usually seen within three months, while permanent findings can be limited to tooth loss [ 2 ]. In cases where gastrointestinal etiology is suspected and absorption of nutrients is compromised, oral supplement may prove ineffective, therefore intravenous administration is required to elevate and stabilize serum levels of ascorbic acid to its normal range [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Effective treatment of scurvy usually leads to symptomatic improvement with complete recovery within months of treatment onset [ 2 ]. Recent reports of patients with unresolved symptoms were found to have gastrointestinal comorbidities such as inflammatory bowel disease (IBD) and celiac disease (CD), suggesting a malabsorptive etiology of scurvy [ 5 , 7 ]. Although malabsorption may lead to a higher risk of scurvy, intravenous vitamin C supplementation and pharmacological treatment of the gastrointestinal disorder resolves symptoms in most patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Presentation of Scurvy in a Well-Nourished Patient

Robin,

Maier

et al. 2023

Cureus

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Vitamin C deficiency, otherwise known as scurvy, is a rare diagnosis among populations with adequate nutritional resources. We present a 37-year-old female patient with bilateral lower extremity edema, episodic anasarca, petechiae, and easy bruising who was diagnosed with scurvy. Given the clinical presentation, a broad differential was investigated with no findings suggestive of hematologic or cardiovascular pathology. Initial laboratory studies were unremarkable. Progression of cutaneous symptoms and subsequent laboratory findings demonstrating low vitamin C levels supported a diagnosis of scurvy. Classical symptoms of scurvy include mucocutaneous petechiae, poor wound healing, ecchymosis, hyperkeratosis, corkscrew hair, gingival swelling, and bleeding gums. Following standard enteral supplementation of vitamin C, repeat vitamin C levels failed to adequately respond with the patient remaining to be symptomatic. Given a lack of insufficient nutritional intake or known systemic illness, gastrointestinal malabsorptive etiology was suspected. Though rare in the United States, scurvy should be considered in patients with manifestations of a bleeding disorder. A gastrointestinal workup may be indicated if other nutritional deficiencies are identified, or a source of inadequate intake cannot be established.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Rare Presentation of Scurvy in a Well-Nourished Patient

Robin,

Maier

et al. 2023

Cureus

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“…Neuropsychiatric or developmental disorders, such as autism spectrum disorders, cerebral palsy and developmental delay, are the most common, as these patients are more prone to restrictive diets owing to sensory issues ( 3 , 13 – 15 ). Other diseases may increase the risk of vitamin C deficiency by reducing its absorption (Crohn's, Whipple's, and celiac disease) ( 16 ), increasing its requirement (chemotherapy, bone marrow transplant, hemodialysis) ( 17 – 19 ), or accelerating its catabolism (iron overload) ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital

et al. 2022

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The limping child frequently represents a diagnostic challenge. The differential diagnosis is broad and should include vitamin C deficiency. Scurvy, resulting from vitamin C deficiency, is the oldest-known nutritional disorder. Despite its rarity in developed countries, scurvy has been increasingly reported in recent years in pediatric patients, particularly those with autism or neurological disabilities. In the present retrospective study, we describe the clinical, laboratory, and radiological features of 8 patients diagnosed with scurvy in the Pediatrics Unit of Meyer Children's University Hospital, between January 2016 and December 2021. The majority (87%) were males, and the median age was 3.7 years. Half of the patients had comorbidities known to be risk factors for scurvy, while the remaining patients were previously healthy. All the children were admitted for musculoskeletal symptoms, ranging from lower limb pain (87%) to overt limping (87%). Mucocutaneous involvement was observed in 75% cases. Microcytic anemia and elevated inflammatory markers were common laboratory findings. Bone radiographs, performed on all patients, were often interpreted as normal at first, with osteopenia (62%) as the most frequent finding; notably, after re-examination, they were reported as consistent with scurvy in four patients. The most common magnetic resonance imaging findings were multifocal symmetrical increased signal on STIR sequence within metaphysis, with varying degrees of bone marrow enhancement, adjacent periosteal elevation and soft tissue swelling. Differential diagnosis was challenging and frequently required invasive diagnostic procedures like bone marrow biopsy, performed in the first three patients of our series. The median time frame between clinical onset and the final diagnosis was 35 days. Notably, the interval times between admission and diagnosis become progressively shorter during the study period, ranging from 44 to 2 days. Treatment with oral vitamin C led to improvement/resolution of symptoms in all cases. In conclusion, scurvy should be considered in the differential diagnosis in a limping child, performing a detailed dietary history and careful physical examination, looking for mucocutaneous lesions. A quick and correct diagnostic path avoids invasive diagnostic procedures and reduces the risk of long-term complications.

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Vitamin C Status of US Adults Assessed as Part of the National Health and Nutrition Examination Survey Remained Unchanged between 2003–2006 and 2017–2018

Powers

Sternberg

Patel

et al. 2023

The Journal of Applied Laboratory Medicine

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Background We compared serum vitamin C (VIC) status of the adult (≥20 y) US population in the National Health and Nutrition Examination Survey (NHANES) 2017–2018 with combined data from 2003–2004 and 2005–2006. Methods VIC was measured using HPLC with electrochemical detection. Mean data were stratified by age, sex, race/Hispanic origin, income, body mass index, dietary intake, supplement use, and smoking status. Prevalence of VIC deficiency (<11.4 μmol/L) was calculated. Results In NHANES 2017–2018, the mean VIC was 8 μmol/L higher in people ≥60 y compared with those 20–59 y of age, 10 μmol/L lower in men vs women, 8 μmol/L lower in low vs high income, 11 μmol/L lower in obese vs healthy weight, and 15 μmol/L lower in smokers vs nonsmokers. Differences in mean VIC across race/Hispanic origin groups ranged from 2 to 7 μmol/L. Mean VIC was 27 μmol/L higher with vitamin C-containing supplement use and positively associated (Spearman ρ = 0.33; P < 0.0001) with increasing dietary intake. The associations between mean VIC and the investigated covariates were generally consistent and the prevalence of deficiency was not significantly different between survey periods (6.8% vs 7.0%; P = 0.83). However, a few subgroups had double the risk. We found no significant survey differences in mean VIC (51.2 vs 54.0 μmol/L; P = 0.09). Conclusions Overall VIC status of the US adult population has remained stable since last assessed in the NHANES 2005–2006 survey. Vitamin C deficiency remained high for those with low dietary intake and who smoke.

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Sailing the ship of life: scurvy and autoimmunity . . .

Cited by 5 publications

References 14 publications

A Rare Presentation of Scurvy in a Well-Nourished Patient

A Rare Presentation of Scurvy in a Well-Nourished Patient

When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital

Vitamin C Status of US Adults Assessed as Part of the National Health and Nutrition Examination Survey Remained Unchanged between 2003–2006 and 2017–2018

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