Scurvy, Starvation, and Flea Infestation – A Case Report From 21st Century Europe

Abstract

Scurvy is a disease caused by vitamin C deficiency, historically associated with long sea voyages, periods of famine and war. Currently, it is often misdiagnosed and underreported, as physicians tend to consider it a disease of the past. We present the case of a 79-year-old female who was admitted to the Emergency Department complaining of pruritus. The patient lived alone and in poor hygiene conditions. Diet was scarce. One week before admission she was in contact with flea-ridden stray dogs. Sometime later she noted several fleas and multiple pruritic small papules, crusts, and excoriations on her torso, limbs, palms, soles, and scalp. Physical examination showed the patient to be pale, emaciated, and poorly groomed. Laboratory analysis showed microcytic anemia. Flea bites were treated with oral antihistamines and prednisolone. Follow-up one month later showed weight gain and partial resolution of skin lesions. However, multiple small ecchymosis on both lower and upper limbs, and occasional perifollicular petechias on her lower extremities, were noted. Additional workup showed undetectable serum vitamin C levels. A diagnosis of scurvy was made. The patient was treated with 1000 mg per day of oral vitamin C for one month leading to complete recovery. We present this case to remind that early recognition of vitamin C deficiency and appropriate supplementation are essential in patients with scurvy. Physicians should be aware of classic signs, symptoms, and social factors associated with this forgotten disease.

The Impact of Chronic Kidney Disease on Nutritional Status and Its Possible Relation with Oral Diseases

“…Vitamin C plasma levels can decrease, not only due to food deficits, but also from infections and post-surgical stress [ 116 ], because, as described previously, this vitamin is involved in tissue repair processes [ 117 , 118 , 119 ]. The diagnosis of scurvy is based on the typical clinical signs of hypovitaminosis and on the resolution of these signs after the intake of vitamin C. Vitamin C serum levels lower than 0.2 mg/dL indicate scurvy [ 120 ] and its treatment relies on an appropriate intake from diet and/or correct vitamin C supplementation [ 120 ].…”