Scurvy (Vitamin C Deficiency) - Diagnosis and Management



Vitamin C is required for hydroxylation of proline residues on procollagen molecules, which support the triple-helix structure of collagen that underpins the integrity of:

• Skin

• Vessels

• Mucous membranes

• Bone



Groups at risk for scurvy:

• Inadequate intake of fresh fruit and vegetables

• Persons with psychiatric illnesses

• Eating disorders

• Selective eating habits

• Infants who consume only pasteurized milk

• Children with autism spectrum disorder, persons with alcohol use disorder

• Isolated elderly persons with poor nutrition



Clinical Presentation:

• General malaise and lethargy

• Poor appetite and failure to thrive

• Ill temper

• Fever and tachypnea

As the condition progresses, shortness of breath, wasting, anemia, edema, mucocutaneous changes, ocular and musculoskeletal symptoms develop.



Psychiatric symptoms:

• Mood disturbances

• Depression

• Cognitive impairment

• Delusions

Ocular:

• Eye dryness and irritation

• Subconjunctival, periorbital, or orbital hemorrhage

Mouth:

• Gingival hemorrhages

• Loss of teeth

Anemia:

• Vitamin C deficiency can lead to iron and folate deficiencies

• Vit C contributes to red-cell cytoskeleton protein beta-spectrin, which is crucial to the structure and integrity of the cell. The loss of beta-spectrin can contribute to nonimmune hemolysis

MSK:

• Hemarthrosis

• Myalgias

• Weakness

• Muscle cramping

Skin:

• Petechia

• Purpura

• Perifollicular hemorrhages

• Corkscrew hairs

• Poor wound healing

• Follicular hyperkeratosis



DDX?

• Petechiae, purpura, and ecchymoses due to capillaritis, cutaneous vasculitis, thrombocytopenia, or any other cause

• Folliculitis

• Gingivitis and periodontitis

• ITP

• Henoch-Schonlein purpura

• DIC

• Rocky Mountain spotted fever

• Meningococcemia

• Hypersensitivity vasculitis



Treatment:

• Supplementation with 1 g/day of oral vitamin C for 2 weeks



#Scurvy #Pathophysiology #VitaminC #AscorbicAcid #Pathophysiology #Nutrition #Diagnosis #Management