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Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.

This review article focuses on the dermatologic manifestations of selected nutrient deficiencies, including protein-energy and micronutrient-related malnutrition. The various nutrient deficiencies presented may share common features. However, distinctive cutaneous signs may prompt clinicians to consider a nutritional cause and help distinguish a nutrient deficiency from other common dermatologic conditions. The recent reemergence of forgotten nutritional deficiencies, such as scurvy and pellagra, in the context of predisposing risk factors that may uniquely affect women more than men makes this topic timely. Recognition of nutritional disorders is important because appropriate treatment may reverse cutaneous signs and prevent irreversible sequelae.

Hypovitaminosis C, or scurvy, is thought to be an uncommon condition. Although prevalent in the 19th century, its ease of absorption and availability in a general diet has greatly reduced its incidence. Vitamin C is necessary for a number of physiological processes and deficiency can result in a number of complications including bleeding/bruising, anaemia and gingival hyperplasia. This case report demonstrates a case of hypovitaminosis C presenting to a tertiary hospital related to poor dietary intake in a patient with behavioural medical conditions. Treatment consisted of oral supplementation of vitamin C with almost immediate resolution of presenting symptoms.

In October 2016, we received reports of five deaths among prisoners with leg swelling of unknown etiology in southwestern Ethiopia. A descriptive cross-sectional study was conducted to investigate the outbreak. A suspected case was defined as a prisoner with leg swelling of unknown etiology noted between May 15, 2016 and November 29, 2016. A total of 118 suspected cases were identified with unilateral or bilateral leg swelling without an identifiable cause from a total of 2,790 prisoners. Eight of the suspected cases were thoroughly examined, and seven of these suspected cases had clinical findings consistent with scurvy. Three of the clinical cases had undetectable vitamin C levels in the serum. The attack rate for the prison was 4.2% (118/2,790), and 11 deaths were identified, making the case fatality rate 9.3% (11/118). Clinical cases of scurvy had symptoms of fatigue, myalgia, arthralgia, and signs of follicular hyperkeratosis, petechiae, peripheral edema, and oral lesions. All clinical cases had severe anemia with hemoglobin < 6.0 g/dL. The diet provided by the prison excluded fruits and vegetables. Scurvy was determined to be the cause of the outbreak, and vitamin C supplementation was promptly initiated. All symptomatic prisoners improved, and no further cases were identified in a 4-week follow-up period of active surveillance.

Background Scurvy is a nutritional vitamin C deficiency disease which shows classical signs on radiographs most commonly along long bones with subperiosteal hemorrhage being a classical finding. Primary presentation of scurvy with orbital hemorrhage presenting as proptosis is however uncommon. Case presentation We report an unusual primary presentation of scurvy in a 4-year-old boy with West syndrome and global developmental delay who presented to the emergency with complaints of bilateral proptosis and eyelid swelling (right > left) which on examination revealed bluish discolouration of bilateral eyelids. On further multimodality imaging investigation, orbital subperiosteal hemorrhages were identified as the cause, along with classical radiographic features of scurvy in bilateral lower limb long bones. The diagnosis was further bolstered by rapid resolution of periorbital ecchymosis after initiating oral vitamin C supplementation. Conclusion To the best of our knowledge, primary presentation of scurvy in the form of bilateral proptosis due to orbital hemorrhages although uncommon can still be a manifestation of scurvy in addition to the more routinely detected subperiosteal hemorrhages along long bones. The significance of establishing the aetiology in such cases of orbital hemorrhage cannot be overemphasised, in view of drastic clinical recovery after starting vitamin C therapy.

Objective This research attempts a differential diagnosis of skeletal lesions in a commingled sample from Hisban, Jordan, focusing on non-adults in the assemblage. Materials 2,883 well-preserved skeletal elements and 9 relatively complete skulls representing an MNI of 32 non-adults ( Methods All skeletal elements were observed macroscopically and pathophysiological processes underlying any lesions or other anomalies were assessed, followed by a comparative approach to rule out potential diagnoses. Results The skeletal lesions observed were caused by inflammation due to chronic hemorrhaging, marrow hyperplasia due to an increase in hemopoiesis, rapid bone growth, and the impact of biomechanical strain on poorly mineralized elements. Rickets, scurvy, and acquired anemias best fit this pattern of lesions, although inflammation from other sources such as trauma or infection could not be definitively ruled out. Conclusions The in utero and postnatal environments at Hisban were conducive to the development of vitamin C and D deficiencies from birth until 2 years of age. The analysis of commingled remains requires an ontological shift in the importance of the individual to the population in paleopathology. Significance This investigation demonstrates the efficacy of a combined biological and comparative approach in differential diagnosis in complicated commingled collections. In addition, it emphasizes the importance of the mother-infant dyad in understanding metabolic disease. Limitations Histological and radiographic analyses were not included in this diagnostic study due to COVID-19 travel restrictions. Suggestions for further research Isotopic analysis to investigate childhood diet and histological and radiographic analyses to assess survival of deficiencies.

Scurvy, a condition caused by vitamin C deficiency, is rare, especially in high-income countries. Symptoms of scurvy are typically characterised by dermatological disorders such as poor wound healing and tooth loss, but there is not usually cardiac involvement. A case of reversible pulmonary hypertension and right-sided heart failure owing to scurvy in a 7-year-old boy with autism spectrum disorder is reported. He had a very restricted diet and presented with polyarthralgia, gingival hyperplasia with ecchymosis, and fatigue. His condition, including pulmonary hypertension and right-sided heart failure, completely resolved with vitamin C supplementation. Paediatricians should have a high index of suspicion for scurvy in children with nutritional selectivity and be aware that it can manifest with cardiac symptoms. Scurvy may be life-threatening if not treated, but the symptoms can improve rapidly with vitamin C supplementation.

We present a rare case of pediatric scurvy in a 9-year-old male who presented with nontraumatic knee pain. MRI was obtained due to the puzzling presentation. MRI demonstrated a systemic bone marrow abnormality which led to a conversation with the clinician and further elucidation of an extremely narrow diet lacking sufficient vitamin C (ascorbic acid). Diagnosis was confirmed biochemically with undetectable ascorbic acid level and clinically with compatible exam and history. This case highlights a thought process for unexpected bone marrow abnormality on MRI.

Ascorbic acid (AA) is an essential nutrient with many physiologic roles not limited to the prevention of scurvy. Beyond its role as a supplement, it has gained popularity in the acute care setting as an inexpensive medication for a variety of conditions. Because of limitations with absorption of oral formulations and reduced serum concentrations observed in acute illness, intravenous (IV) administration, and higher doses, may be needed to produce the desired serum concentrations for a particular indication. Following a PubMed search, we reviewed published studies relevant to AA in the acute care setting and summarized the results in a narrative review. In the acute care setting, AA may be used for improved wound healing, improved organ function in sepsis and acute respiratory distress syndrome, faster resolution of vasoplegic shock after cardiac surgery, reduction of resuscitative fluids in severe burn injury, and as an adjunctive analgesic, among other uses. Each indication differs in its level of evidence supporting exogenous administration of AA, but overall, AA was not commonly associated with adverse effects in the identified studies. Use of AA remains an active area of clinical investigation for various indications in the acute care patient population.

Ernest Shackleton, an accomplished Antarctic explorer, developed a life-threatening illness during the Discovery Antarctic expedition of 1901–4. His documented signs and symptoms included inflamed gums attributed to scurvy, severe dyspnea, and exercise intolerance, presenting in a setting of nutritional deficiency. Physical examinations at a later date, also following a prolonged diet of limited fresh food, revealed a pulmonary systolic murmur. Thiamine deficiency with cardiomyopathy, either alone or subsequently exacerbated by advanced scurvy, may have been a prominent cause of Shackleton’s condition.

Background The demographics, weight statuses, and dietary patterns of people with autism or the broad autism phenotype who experience a severe nutrient deficiency disease due to symptoms of avoidant/restrictive food intake disorder have not been well established. Objective The primary objective of this review was to examine the relationship between the demographics, weight statuses, dietary patterns, and nutrient deficiency diseases that characterize the most severe manifestations of avoidant/restrictive food intake disorder symptomology associated with autism or the broad autism phenotype. Methods A systematic review of English and non-English articles published up to August 29, 2019, on the Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature Plus electronic databases was conducted. Additional cases were identified through the reference list of all included articles. The search terms used were “autis∗ AND (deficiency OR scurvy)”. Only case reports or case series in which a person of any age who had been identified as having a formal diagnosis of autism or autism symptoms and a disease of nutritional deficiency due to self-imposed dietary restrictions were included. Data were independently extracted by 8 authors using predefined data fields. Results A total of 76 cases (patients were aged 2.5 to 17 years) from 63 articles that were published from 1993 through 2019 were found. More than 85% cases (65 of 76 patients) were from articles published in the past 10 years. The largest percentage of published cases (69.7% [53 of 76]) involved scurvy, a vitamin C deficiency. The second-largest percentage of published cases (17.1% [13 of 76]) involved eye disorders secondary to vitamin A deficiency. Other primary nutrient deficiencies reported were thiamin, vitamin B-12, and vitamin D. In 62.9% (22 of 35) of the patients for which a body mass index or a weight percentile for age was provided, the patient was within normal weight parameters, per Centers for Disease Control weight status categories. Conclusions Based on the 63 articles extracted for this systematic review, nutritional deficiency diseases related to inadequate intakes of vitamin A, thiamin, vitamin B-12, vitamin C, and vitamin D were found in individuals with autism and the broad autism phenotype who had severe self-imposed dietary restrictions. When weight information was provided, most of the youth in these cases were not reported to be underweight. Individuals of any weight who present with symptoms of avoidant/restrictive food intake disorder can benefit from early and frequent screening for adequacy of micronutrient intake, regardless of whether they have a clinical diagnosis of autism.

Resume Introduction Le scorbut resulte d’une carence en acide ascorbique (vitamine C). Bien qu’il soit actuellement rare dans les pays occidentaux, le diagnostic est parfois pose dans certaines populations sensibles, en particulier les sujets âges et les personnes ayant des habitudes alimentaires ne permettant pas un apport suffisant en vitamine C. Observations Nous rapportons deux cas d’hommes, âges de 87 et 69 ans, qui ont presente une ulceration progressive, sans cicatrisation des membres inferieurs, polyfactorielle, dans un contexte d’arteriopathie et de comorbidites associees. Un scorbut a ete suspecte devant des ulceres necrotiques et un purpura des membres inferieurs. Dans les deux cas, le niveau de vitamine C etait indetectable. Une amelioration sur la composante necrotique et du purpura a ete observee rapidement apres une supplementation en vitamine C. Conclusions Le diagnostic du scorbut peut etre difficile. Ces observations soulignent l’importance de rechercher un scorbut devant des ulcerations atypiques des membres inferieurs ne repondant pas au traitement standard, en particulier dans les populations a haut risque de carence en vitamine C. Un diagnostic precoce peut ameliorer le pronostic du patient.

Scurvy is a rare case found in many countries, but it is often found in refugee areas, especially in Africa. Vitamin C deficiency varies based on season and occurs more in men with age. The purpose of this research is to avoid misdiagnosis so that it can be a reference in the field of medicine to diagnose and provide management onscurvy. This prospective research was conducted with one sample of research. Observation had been carried out for two months, starting at one month after the patient was suspected with the diagnosis of scurvy. Computer Tomography (CT) Scan lumbosacral to pelvic results were normal. Laboratory test of HB result was 9.5 g/dl, in which MCV was 63.2 fL, MCH was 20.3 pg, and MCHC was 32.1 g/dl. Scurvy treatment in the first visit was 3x1 tablets vitamin C, 3x5 ml ibuprofen Syr, and physiotherapy. The results were that the patient still suffered swollen and bleeding gums, but the pain no longer existed, pale, behavioural disorders, unable to walk, and pain in both knees. After the second visit, the child got therapy of 4x50 mg vitamin C, 1x1 tablets vitamin B12, 1x150 IU vitamin E, 1x1 tablets cavit D3, and physiotherapy. After two weeks of treatment, there were no complaints of swelling, painful or bleeding gums. The child could straighten her legs, but she was still unable to walk due to the trauma of feeling great pain while walking. Special attention is required to diagnose appropriately so the doctor can minimize and prevent complications.

The presented report describes the skeletal remains of a young man with multiple pathological changes, dated to between 3800-3700 BC. The studied skeletal remains were subjected to classical anthropological analysis. The palaeopathological study was based on detailed macroscopic examination supplemented by histological and radiological examinations. In addition to the disorder of flat cranial bones, dental developmental defects, traces after periodontal and sinus maxillaris inflammation, partially fractured left rib and fracture of the first lumbar vertebra were found on this skeleton. Based on the mentioned examinations, this finding was evaluated as one of the possibly oldest cases of scurvy in Europe.

The article analyses the problem of implementing legislation on medical care in the army during the reign of Peter the Great and Anna Ioannovna. The Admiralty Regulations of 1722 and the General Regulations on Hospitals of 1735 announced meticulously prescribed standards for taking care of patients in military hospitals, as well as the number, qualifications and duties of medical personnel in those centers. According to scholars, both documents represent bright examples of the authorities’ faith in the possibility of resolving of crisis in the work of any institution by detailed regulation of all aspects of its activities. However, a research on conditions of service of army employees and state of military health care implies a study based on local material and functioning of certain hospitals. The author focuses on the history of medical institutions in fortresses located on the Russian-Swedish border. The study was carried out on the basis of reports received in St. Petersburg from the border fortresses and devoted to the number of sick employees in the Vyborg and Kexholm garrisons, their diseases and providing them medical care. It is revealed that the military infirmaries have been opened in Vyborg and Kexholm in the early 1720s. And the number and qualifications of the medical personnel met the requirements of the state legislation. Nevertheless, the employees of the local garrisons suffered the same hardships as military men in other north-western fortresses (St. Petersburg, Kronstadt, Riga). This is indicated by the spread of diseases typical for the northern regions and poorly victualled communities, limited in access to proper food and clean sources of water (scurvy, typhus, digestive disorders). Along with that, the region had its own specifics: despite the harsh climate, work on fortifications was carried out from early Spring. Therefore, the soldiers were often hospitalised due to frostbite and colds. From the number of employees sent to the hospital for treatment 66 % died within six months. The most vulnerable group were employees of the first and second years of service under the age of 30. However, the situation in the fortresses did not become critical and epidemics were avoided.

Introduction: Scurvy is a rarely seen in pediatric patients nowadays, seen more in those with developmental delay, autism or those who are severely malnourished. Epiphyseal separations are known to occur in scurvy, but only a few such cases have been reported in children with cerebral palsy. The diagnosis is often misleading since other morbidities as trauma, malignancies, coagulopathies, septic arthritis, osteomyelitis, or rheumatologic disorders are often considered at first. We report the case of 4-year-old female child with cerebral palsy in whom the initial concern was septic arthritis/osteomyelitis based upon clinical presentation, ultrasonic and magnetic resonance imaging, led to a surgery revealing subperiosteal hematomas. Case Report: A 4-year-old girl was admitted in the pediatrics department for fever and bilateral knee joint pain for 3 days. She was a diagnosed case of with cerebral palsy, psyco-developmental delay, and epileptogenic disorder put under valproic acid. She was toxic and febrile. Within 4 h after admission, both knees developed tense shiny intense swelling associated with pain, redness, and local rise of temperature with limited active range of motion. Near-complete passive range of motion was noted. There were no abnormal findings on the rest of the musculoskeletal examination. Aspiration of the knee revealed subperiosteal hematoma diagnostic of scurvy. Conclusion: Scurvy is exceedingly rare in children nowadays; however, its presentation among risky populations should not be forgotten. Musculoskeletal revelations, mostly subperiosteal hematoma, are the main manifestation of scurvy in the pediatric population. Scurvy as a differential diagnosis for trauma, osteomyelitis, septic arthritis will always be a bane for orthopedic surgeons. A heightened awareness is needed to avoid unnecessary surgery, unnecessary tests, and procedures and to be able to start treatment for a potentially fatal but easily curable disease. Keywords: Scurvy, cereb

Ascorbic acid (vitamin C) functions as a cofactor and antioxidant within the human body that enables tissue growth and repair, but vitamin C is not intrinsically produced. Scurvy, or ascorbic acid deficiency, has traditionally been viewed as a historical disease. With the incidence of autism spectrum disorder and food restriction on the rise, children's hospitals may see increasing cases of scurvy. This is a single-center, retrospective case series including patients aged 7 to 14 years who were admitted to the Kentucky Children's Hospital with scurvy in the 2018–2019 period. Although selective or restricted eating is not an uncommon behavior among children, especially toddlers, parents of autistic children frequently report their children to be exceedingly selective eaters. However, there currently are conflicting findings on whether this leads to nutritional inadequacy. Although no guidelines exist for the treatment of scurvy, the mainstay of therapy is reintroduction of vitamin C. Oral therapy is generally preferred, but vitamin C can be given parenterally when necessary. In conclusion, oral aversion is a symptom commonly seen in patients with autism spectrum disorder and other developmental delays, potentially leading to increased cases of scurvy. Treatment of scurvy includes reintroduction of vitamin C into the diet. However, oral supplementation may pose unique challenges in this patient population.

The presented study is a part of a complex study focused on monitoring the origin and development of paediatric care in Moravia, one of the countries of the former Austrian monarchy. The work also takes into account the social conditions, as changes in the Moravian healthcare sector occurred in the period under review in connection with the Theresian and Josephine reforms. Neonatal mortality was very high at the time, including, among other things, the lack of care for mothers-to-be. The study observes the state of health and the causes of paediatric mortality from the 13th to the 19th centuries, on the basis of the study of available literary sources within the context of palaeopathological analyses of children's skeletal remains. The analysis of adult skeletons of the study population provides evidence of high female mortality between 20-30 years of age. The attention was focused on congenital malformations, metabolic and hematogenic diseases. From congenital malformations, palaeopathological analysis confirmed the developmental dysplasia of the hip and the premature obliteration of cranial sutures in the examined child population. From the haematologic and metabolic diseases, the manifestations of anemia in the form of cribra orbitalia, signs of scurvy and rickets were most frequently reported. These diseases were reported mainly in children in foundling homes and orphanages. According to literary sources, their numbers grew significantly in connection with famine-related war incidents. Therefore, the results of the study provide direct evidence of the occurrence of observed childhood illnesses in Moravia during the period of modern times.

Parents and caretakers are increasingly feeding infants and young children plant-based "milk" (PBM) alternatives to cow milk (CM). The US Food and Drug Administration currently defines "milk" and related milk products by the product source and the inherent nutrients provided by bovine milk. Substitution of a milk that does not provide a similar nutritional profile to CM can be deleterious to a child's nutritional status, growth, and development. Milk's contribution to the protein intake of young children is especially important. For almond or rice milk, an 8 oz serving provides only about 2% or 8%, respectively, of the protein equivalent found in a serving of CM. Adverse effects from the misuse of certain plant-based beverages have been well-documented and include failure to gain weight, decreased stature, kwashiorkor, electrolyte disorders, kidney stones, and severe nutrient deficiencies including iron deficiency anemia, rickets, and scurvy. Such adverse nutritional outcomes are largely preventable. It is the position of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Nutrition Committee, on behalf of the society, that only appropriate commercial infant formulas be used as alternatives to human milk in the first year of life. In young children beyond the first year of life requiring a dairy-free diet, commercial formula may be a preferable alternative to cow's milk, when such formula constitutes a substantial source of otherwise absent or reduced nutrients (eg, protein, calcium, vitamin D) in the child's restricted diet. Consumer education is required to clarify that PBMs do not represent an equivalent source of such nutrients. In this position paper, we provide specific recommendations for clinical care, labelling, and needed research relative to PBMs.

El escorbuto es una enfermedad causada por la deficiencia de vitamina C o ácido ascórbico. Sus manifestaciones clínicas son variadas debido a que esa vitamina es un cofactor de enzimas que intervienen en numerosos procesos, como la síntesis de colágeno y la absorción de diferentes nutrientes. La expresión cutánea característica son las petequias foliculares con pelos en cuello de cisne y en tirabuzón. El compromiso mucoso se manifiesta como hipertrofia y hemorragia gingival, gingivitis y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática o leucocitaria. El tratamiento se basa en el aporte suplementario de esa vitamina. Se presenta el caso de un paciente de 32 años con escorbuto debido a una dieta casi exclusivamente a base de harinas y carente de frutas y verduras.

Highlights • Scurvy is a rare condition in pediatric patients. • The rarity and the polymorphisms of the clinical signs and symptoms make scurvy an often unknown or forgotten diagnosis. • Extremely rare occurrence of scurvy in modern society at present time, it is difficult to differentiate it from other diseases such as infection., Introduction Scurvy is a rare condition in pediatric patients, resulted from a vitamin C deficiency. Musculoskeletal symptoms occur in 80% of patient. The rarity and the polymorphisms of the clinical signs and symptoms often make scurvy an unknown or forgotten diagnosis. Methods A 3-years-old boy with limping gait, progressive pain and swelling on his left lower limb since 3 months prior was diagnosed as osteomyelitis based on MRI. When there was no improvement after 2 weeks of IV antibiotic administration, we did surgical debridement procedure. Intraoperative, we found extensive blood clot inside and in the entire periosteum instead of infection. One week after surgery, there was still no improvement clinically and radiographically. Histopathology result suggested a fibro-osseous tumor. After reviewing clinical sign including skin presentation and plain radiology, we suspected scurvy disease in this patient and started a vitamin C therapy course immediately. Results Two weeks after we started vitamin C treatment, the patient’s condition was significantly improved clinically and radiographically. Serial radiograph was taken after 2 and 12 months of surgery, and it showed significant improvement on the site where the previous pathological process appeared. Discussions Because of the extremely rare occurrence of scurvy in modern society at present, it is difficult to differentiate it from other diseases such as infection. The diagnosis of scurvy is made by careful studies from history taking, physical examination, laboratory and especially radiological finding that show pathognomonic appearance. Examination of vitamin C level serum is a gold standard, but unfortunately not available in our country. Improvement after vitamin C administration also established that condition. Conclusion Scurvy should have established by clinical and radiological findings that show pathognomonic signs around joint, even without supported by vitamin C serum.

Nutritional deficiency is very common in pediatric patients, especially in developing countries. A 4-year-old Maldivian boy presented with pain in major joints of lower limbs since two months and was unable to stand and walk since one month. There was no history of fever or fall. The growth was average with mild pallor. There was no joint swelling. Xray knee joint showed epiphyseal separation, cortical thinning suggesting a radiological diagnosis of Scurvy and after Vit C supplementation the child showed clinical and radiological improvement in two weeks. So, a high index of suspicion is required for early diagnosis and treatment.

Vitamin C (ascorbic acid) is an essential water-soluble antioxidant, and deficiency (ie, plasma level

Scurvy is a rare disease caused by a vitamin C deficiency. Vitamin C is a water-soluble vitamin found in vegetables and fruits, but it is lost after boiling. A 59-year-old man presented with gingival pain after having a tooth extracted five years previously. Following the procedure, his diet comprised boiled vegetables to prevent pain. He then experienced bilateral lower leg pain, and computed tomography revealed intramuscular bleeding. His serum vitamin C level was below the detectable limit. His symptoms immediately improved with vitamin C administration. This case emphasized that consuming only boiled vegetables can lead to the onset of scurvy.

Scurvy is a vitamin deficiency historically associated with pirates and sailors that affects collagen synthesis, leading to hemorrhage, skin, and oral lesions. In the 18th century, the lack of consumption of foods rich in vitamin C was found to cause such a severe condition, whose early diagnosis increases the likelihood of a better prognosis. A 58-year-old female patient complained of fatigue, body pain, and gingival bleeding for nearly 24 months. In 2001, she was diagnosed with lupus, now in remission, and osteoporosis more recently. On clinical examination, gingivitis with spontaneous bleeding was observed, despite the patient’s good hygiene, as well as some petechiae over the body. Due to the hypothesis of a possible autoimmune dermatological disease, the patient was referred to a dermatologist, who requested a series of tests, including vitamin C dosage. The results showed a concentration below 0.25mg / dL (IR, 4 to 2.0 mg / dL), and thus the diagnosis of scurvy was established. The patient was administered vitamin C replacement and in about 3 months, the symptoms started to improve. In some cases, such as this, hospitalization is required for intravenous replacement due to bleeding risks. This case report highlights the importance of the dentist in the early diagnosis and treatment of scurvy. This condition causes oral lesions that are often confused with other more common conditions, such as gingivitis or autoimmune dermatological response. Therefore, we recommend a comprehensive physical examination and anamnesis, including dietary history. El escorbuto es una deficiencia de vitaminas históricamente asociada con piratas y marineros, la cual afecta la síntesis de colágeno, provocando hemorragias, lesiones cutáneas y orales. En el siglo XVIII, se descubrió que la falta de consumo de alimentos ricos en vitamina C provocaba esta grave afección, cuyo diagnóstico precoz aumenta la probabilidad de un mejor pronóstico. Una paciente de 58 años se quejó de fatiga, dolor corporal y sangrado gingival durante casi 24 meses. En 2001, le diagnosticaron lupus, ahora en remisión, y osteoporosis hace un mes. En el examen clínico, se observó gingivitis con sangrado espontáneo, a pesar de la buena higiene de la paciente, así como algunas petequias en su cuerpo. Ante la hipótesis de una posible enfermedad dermatológica autoinmune, la paciente fue referida a un dermatólogo para una serie de pruebas, incluida la dosificación de vitamina C. Los resultados mostraron una concentración por debajo de 0,25 mg / dL (RI, 4 a 2,0 mg / dL), por lo que se estableció el diagnóstico de escorbuto. La paciente fue tratada con reemplazo de vitamina C y, en aproximadamente 3 meses, los síntomas comenzaron a mejorar. En algunos casos, como este, se requiere hospitalización para el reemplazo intravenoso debido a los riesgos de hemorragia. Este caso clínico destaca la importancia del odontólogo en el diagnóstico y tratamiento precoz del escorbuto. Esta afección provoca lesiones orales que frecuentemente se confunden con otras afecciones más comunes, como la gingivitis o la respuesta dermatológica autoinmune. Por lo tanto, recomendamos un examen físico completo y una anamnesis, incluida la historia dietética. O escorbuto é uma deficiência vitamínica historicamente associada a piratas e marinheiros, a qual afeta a síntese de colágeno, levando a hemorragias, lesões cutâneas e orais. No século 18, constatou-se que a falta de consumo de alimentos ricos em vitamina C causava esse quadro grave, cujo diagnóstico precoce pode aumentar a probabilidade de um melhor prognóstico. Uma paciente do sexo feminino, 58 anos, com queixa de fadiga, dores no corpo e sangramento gengival há quase 24 meses. Em 2001, ela foi diagnosticada com lúpus, agora em remissão, e osteoporose mais recentemente. Ao exame clínico, observou-se gengivite com sangramento espontâneo, apesar da boa higiene da paciente, além de algumas petéquias pelo corpo. Devido à hipótese de uma possível doença dermatológica autoimune, o paciente foi encaminhado a um dermatologista, que solicitou uma série de exames, incluindo dosagem de vitamina C. Os resultados mostraram concentração abaixo de 0,25mg / dL (RI, 4 a 2,0mg / dL), estabelecendo assim o diagnóstico de escorbuto. O paciente recebeu reposição de vitamina C e, em cerca de 3 meses, os sintomas começaram a melhorar. Em alguns casos, como este, é necessária hospitalização para reposição intravenosa devido ao risco de sangramento. Este relato de caso destaca a importância do dentista no diagnóstico precoce e tratamento do escorbuto. Essa condição causa lesões orais que costumam ser confundidas com outras doenças mais comuns, como gengivite ou resposta dermatológica autoimune. Portanto, recomendamos um exame físico abrangente e anamnese, incluindo história alimentar.

Identifying social determinants of health can help diagnose certain nutritional deficiencies. By overcoming these barriers, we can prevent future hospitalizations and better public health. We present a unique case where a 46-year-old man presents with bilateral lower extremity swelling secondary to vitamin C deficiency. Throughout history taking, his social determinants of health were identified and he was diagnosed with scurvy from the suspected poor nutritional intake. His poor nutritional intake could have resulted from a lack of financial stability and a harsh home environment. This case is evidence that social determinants of health can directly impact a patient’s well-being, and as physicians, we need to identify them to provide the most resources we can to help improve patient care. This in turn can decrease unnecessary emergency room visits and hospitalizations.

A 69-year-old man with irritable bowel syndrome on a restricted diet presented with fatigue, myalgias, extensive bilateral lower-extremity petechiae and ecchymoses, transfusion-refractory anemia, and elevated inflammatory markers. A low serum vitamin C level led to the diagnosis of scurvy. This is the first reported case of vitamin C deficiency and clinical scurvy related to voluntary dietary restriction from irritable bowel syndrome in an adult patient.

International audience; A 42 year-old patient presented with circulatory failure and lactic acidosis. Clinical features, later coupled with biological tests, led to the diagnosis of wet beriberi syndrome and scurvy. Echocardiography showed a pattern of thiamine deficiency with high cardiac output and low vascular resistance. The patient's condition and biological parameters immediately improved after treatment injections of thiamine. Wet BeriBeri is often overlooked in western countries and is a diagnosis that must be considered based on history, and clinical and echocardiographical findings.

We report the case of a 14-year-old boy with a completely normal medical and social background (good student and handball practice). A dentist monthly followed this patient for an orthodontic treatment. Facing with symptoms associating purpura, pancytopenia, and limbs pain, the first diagnosis that came to mind to emergency pediatricians was acute leukemia and the patient was addressed to a hematology department. However, additional psychiatry investigations revealed an avoiding restrictive food intake disorder (ARFID) associated with serious vitamin deficiencies (Vitamins B9 and D) and responsible for scurvy, mimicking acute leukemia onset. Strikingly, this young patient has been undergoing a close medical follow-up since infancy because of a selective diet. Since growth, education, and development were normal, the risk of pursuing this unbalanced diet has been neglected and this child was admitted at diagnosis in a life-threatening condition.

Objective To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy. Method We searched MEDLINE, CINAHL, and PsycINFO databases (1990-2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high. Results The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement. Conclusions Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.

Eine Patientin stellte sich mit Belastungsdyspnoe, Myalgien und Petechien der unteren Extremitaten sowie einer ausgepragten Gingivitis vor. Laborchemisch lies sich eine Anamie nachweisen. Bei bekannter Essstorung ergab die Befragung zu den Ernahrungsgewohnheiten, dass die Patientin kein Obst oder Gemuse zu sich nahm. Es stellte sich der Verdacht auf einen Vitamin-C-Mangel, der in der Hochleistungsflussigkeitschromatographie bestatigt wurde. Nach Substitution von 1000 mg Ascorbinsaure taglich waren Anamie und klinische Beschwerden innerhalb weniger Wochen rucklaufig.

The story of vitamin C (L-ascorbic acid) as an antioxidant and a cofactor in numerous biochemical reactions is a part of its long history and it is well known today. However, many questions of its mechanism of action and the benefits that it has on human health are still emerging. This applies not only to the recommended doses but also to the route of its administration. Besides, there are numerous questions about the therapeutic efficacy of vitamin C in various human (infectious) diseases, as well as its immune system function and antiviral potential. The fact that vitamin C can act as a reductant (antioxidant) and a prooxidant further emphasizes its oxidation-reduction (redox) potential in real physiological conditions. Today, the question of the intravenous administration of vitamin C effect in patients with SARS-CoV-2 requires special attention. This review aims to showcase known facts about vitamin C and its mechanisms of action to better understand the current new challenges related to vitamin C.

Humans have lost their vitamin C-synthesizing capacities during evolution. Therefore, the uptake of this essential compound from external sources is mandatory in order to prevent vitamin C-deficient conditions resulting in severe morbidities such as scurvy. The potent antioxidant, immunomodulatory, and antiinfectious effects of vitamin C are known since the 1930s. We here (i) review the impact of vitamin C on innate and adaptive immune functions, (ii) provide an overview of its antimicrobial, antibacterial, antiviral, antiparasitic, and antifungal properties, and finally, (iii) discuss vitamin C as an adjunct treatment option for the combat of human infections by bacteria, particularly by emerging multidrug-resistant species.

Scurvy is a disorder of vitamin C deficiency which leads to vascular fragility and multisystemic complications. The paper presents a case of scurvy…, Scurvy is a disorder of vitamin C deficiency which leads to vascular fragility and multisystemic complications. The paper presents a case of scurvy resulting in cardiac tamponade in addition to its classic manifestations. Life-threatening tamponade is an extreme presentation of scurvy and has not been reported in modern publications to the best of the present authors’ knowledge. (Level of Difficulty: Beginner.), Graphical abstract

Background Scurvy is one of the oldest diseases known to mankind. Although presently rare in the developed world, scurvy was a common potentially fatal disease. In recent times, the most common risk factors for scurvy include alcoholism, low socioeconomic status, and severely poor nutrition or dietary restriction secondary to psychiatric illness or developmental disorders. Our case demonstrates the importance of having a high index of clinical suspicion of an uncommon disease in developed countries and emphasizes the necessity of a dietary screening that could potentially reduce extensive work-up in patients with nonspecific complaints. Case presentation We report a case of a 3-year-old previously healthy female originally seen in the rheumatology clinic for limp. She developed weakness and was admitted to the hospital for further evaluation. She underwent extensive diagnostic testing including blood work, magnetic resonance imaging, lumbar puncture, electromyogram, and nerve conduction studies. Ultimately, her vitamin C level returned undetectable. She had immediate and complete improvement upon starting vitamin C supplementation. Conclusions Despite being developmentally appropriate, our patient’s refusal to eat fruits or vegetables had limited her diet, emphasizing the importance of obtaining a diet history in a child presenting with an unknown diagnosis. In addition, our patient had no other characteristic features of scurvy, which further supports the need to consider this diagnosis in a child presenting with lower extremity weakness or abnormal gait.

Pulmonary arterial hypertension (PAH) describes a rare, progressive disease of the pulmonary vasculature, involving a group of clinical conditions that result in precapillary pulmonary hypertension (PH). PAH is characterized by proliferative vasculopathy, and subsequent right heart failure. For the past several decades research has focused on identification of underlying molecular causes of this disease. Recently, there have been a number of reported cases of patients with scurvy developing pulmonary arterial hypertension. Thus, it has been hypothesized that vitamin C deficiency results in non-hypoxic activation of hypoxia inducible transcription factors (HIF) and low nitric oxide (NO) level in the pulmonary vasculature, leading to subsequent pulmonary vasculopathy and an exaggerated pulmonary vasoconstrictive response. Immediate supplementation of vitamin C is considered the definitive treatment, preventing an otherwise fatal outcome. In this paper, we describe a patient with a fatal case of scurvy related PAH, who was admitted with ecchymosis, oral ulceration, and dyspnea.

Scurvy is a historically significant disease whose incidence has declined significantly with advancements in nutrition and access to varied foods. It is classically characterized by gingival bleeding, corkscrew hairs, and petechiae. In cases of severe deficiency, as seen in patients with years of a restricted diet, impaired connective tissue formation can lead to symptomatic, life-threatening bleeding diathesis. Risk factors for a restrictive diet in patients with unidentified bleeding diathesis should be recognized early to prevent significant morbidity.