Search

Background Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. Objectives In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. Methods A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. Results Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P  = 0.015) and using excessive amounts of alcohol and tobacco (P  = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33–13.86; P  = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05–8.19, P  = 0.031) (n = 160). Conclusions VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. Systematic Review Registration Open Science Framework (https://doi.org/10.17605/OSF.IO/AJGHX). [ABSTRACT FROM AUTHOR]

Scurvy, once prevalent among sailors, is now rare due to improved access to fresh fruits and vegetables yet persists in individuals with poor dietary habits. We report a case of a 35‐year‐old male presenting with month‐long, nonpainful, nonitchy lower extremity lesions. A dermatological examination revealed follicular hyperkeratosis, perifollicular bleeding, corkscrew hairs, bleeding gums, and hemorrhagic purpura. Despite unavailable plasma vitamin C testing, scurvy was diagnosed based on clinical features and dietary history. Treatment with vitamin C resulted in significant improvement within 10 days. Inadequate intake of fruits and vegetables causes vitamin C deficiency, impairing collagen synthesis and leading to typical scurvy symptoms. This case underscores the importance of considering scurvy in patients with compatible symptoms, focusing on clinical diagnosis and treatment response when testing is unavailable. Management includes vitamin C supplementation and dietary changes, emphasizing healthcare providers' role in promoting sufficient fruit and vegetable consumptions to prevent nutritional deficiencies. [ABSTRACT FROM AUTHOR]

Objectives: The osteological paradox recognizes that the presence of lesions is not always directly related with increased mortality. When combined with the clinical, historical, and epidemiological literature on scurvy, survivorship analysis, a form of statistical analysis to assess the relationship between the presence of diseases in the archeological record and survival, helps determine the overall burden of the disease both in terms of morbidity and mortality. This article explores the relationship between scurvy and survivorship in 26 adults from Man Bac, a Neolithic site from northern Vietnam together with prepublished evidence of scurvy in the nonadult population (n = 44). Methods: Diagnosis of scurvy included differential diagnosis combined with the Snoddy, A. M. E., Buckley, H. R., Elliott, G. E., Standen, V. G., Arriaza, B. T., & Halcrow, S. E. (2018). Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide. American Journal of Physical Anthropology, 167(4), 876–895. https://doi.org/10.1002/ajpa.23699 threshold criteria and the Brickley, M. B., & Morgan, B. (2023). Assessing diagnostic certainty for scurvy and rickets in human skeletal remains. American Journal of Biological Anthropology, 181, 637–645 diagnostic certainty approaches. Kaplan–Meier survival curves were produced to assess the relationship between the presence of probable scurvy and age‐at‐death. Results: The prevalence of probable scurvy in adults (35%) was considerably lower than reported for the nonadults (80%). Almost all lesions observed in the adults were in a mixed stage of healing. Kaplan–Meier analysis demonstrated no difference in survivorship between infants and children (<15 years) with or without probable scurvy, whereas a meaningful difference was observed for the adults and adolescents (15+ years). Conclusions: The findings demonstrate that scurvy considerably decreased survivorship to older age categories. The degree of lesion remodeling, however, indicates that scurvy was not necessarily the direct cause of death but contributed to an overall disease burden that was ultimately fatal. [ABSTRACT FROM AUTHOR]

Scurvy is a rare nutritional disorder caused by deficiency of ascorbic acid (vitamin C). It is often under-diagnosed in clinical settings, especially in North America where population statistics are unavailable. However, scurvy is more common than previously thought and appears to be re-emerging in children with developmental delays. Here, we review the pertinent literature and present a case of a previously healthy, 5-year-old, non-verbal boy who presented with multiple, acute, and subacute spontaneous epidural hemorrhages managed by neurosurgical intervention. He remained in hospital for 17 days and was seen in follow-up 3 weeks post-operatively having returned to his neurological baseline. Our case suggests the importance of considering scurvy in patients who have developmental delays and poor nutritional status. [ABSTRACT FROM AUTHOR]

Introduction: Scurvy is caused by vitamin C deficiency and manifests with a variety of symptoms including generalized fatigue, apathy, anemia, myalgias, easy bruising, and poor wound healing. It is generally thought of as a disease of the past, especially in developed countries. However, vitamin C deficiency still occurs, especially in patients with lack of access to fruits and vegetables. Other micronutrient deficiencies, including vitamin D deficiency, are also prevalent and can cause a multitude of signs and symptoms including osteomalacia, muscle weakness, and increased risk of many chronic illnesses.Case Report: Here we present a case of vitamin C and D deficiency in a previously healthy 26-year-old man during the coronavirus disease 2019 pandemic in urban America.Conclusion: Severe nutritional deficiencies still exist today. Emergency clinicians should be aware of the signs and symptoms to promptly diagnose and initiate treatment.

Scurvy is often considered a disease of the past and well described in children with neurodevelopment and autistic spectrum disease. Clinicians overlook the diagnosis of scurvy, leading to unwarranted laboratory investigations and, unfortunately, significant delays in diagnosis. This study aims to describe 10 cases of scurvy in a tertiary hospital setup with their clinical profile, comorbidities, radiological, and subsequent disease course in children presenting to the pediatric rheumatology department at Amrita Hospital, Kochi, from 2017 to 2022. Demographic, imaging, and associated comorbid conditions including neuropsychiatric abnormalities were documented. They were all reviewed in 2 weeks for improvement of symptoms. A total of 10 children (3 females) were included in this study. The disease manifested predominantly in early childhood (median age: 5.5 years). All patients had unexplained bone pain and inability to bear weight. The referral diagnosis of 8/10 patients was juvenile idiopathic arthritis. Two patients had autism as a comorbidity. Selective eating habits and food faddism were present in 2/10 children. All patients have made a full functional recovery at review. All patients had imaging findings suggestive of scurvy. Pediatricians and rheumatologists alike must consider scurvy in a child with unexplained bone pain and symptoms masquerading as primary rheumatological diseases. Selective eating habits need to be treated with timely and appropriate psychological rehabilitation and dietary education. Resolution of symptoms and radiographic features with vitamin C supplementation is the strongest evidence for scurvy.

This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medicine. The main hypothesis is that grasping a mechanistic explanation of a condition is necessary for a biomedical understanding of that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothesis is that clinical understanding combines biomedical understanding of a disease or pathological condition with understanding illness, which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources in addition to those involved in biomedical understanding. [ABSTRACT FROM AUTHOR]

Scurvy is an infrequent pathological condition resulting from a sustained dietary vitamin C deficiency. Radiology becomes pivotal because the diagnostic process for scurvy can be intricate, given its resemblance to bone neoplasms. A 6-year-old boy, reported persistent pain and swelling in the right thigh for 2 months prior to hospitalization. Clinical examination revealed a mass localized in the right thigh and anemia. A radiograph of the right femur demonstrated extensive osteopenic changes, “Trümmerfeld zone”, “Frankel line”, “Pelkin fracture”, “Wimberger ring sign”, and para-epiphyseal subperiosteal hematoma. The absence of any such cases in our institution over the preceding decade emphasizes the uniqueness of this presentation. Histopathological evaluation yielded atypical results, prompting further radiographic assessment of the left femur and thorax. The subsequent findings corroborated the classic “scorbutic rosary” presentation, indicative of scurvy. The patient's symptoms gradually resolved with high-dose supplementation of vitamin C. Scurvy predominantly presents with musculoskeletal manifestations. Plasma vitamin C level assessment is the gold standard for the diagnosis, but it is currently inaccessible in our nation. Consequently, radiographic evaluation reveals pathognomonic features of the disorder. In thoracic radiographs, the “scorbutic rosary” presentation is evident. In contrast, long bones exhibit hallmarks of scurvy: diffuse osteopenia, “Frankel line”, “Trümmerfeld zone”, “Pelkin fracture”, “Wimberger ring sign”, and para-epiphyseal subperiosteal hematoma. Prompt intervention with vitamin C thwarts the progression to severe complications. Radiology is an indispensable tool in diagnosing pediatric scurvy, especially in developmental countries where the assessment of vitamin C serum levels is inaccessible.

Depression is on the rise and medication does not always provide satisfactory relief. This raises the question of a treatment gap that has not yet been (sufficiently) addressed. Inflammation and oxidative stress play an important pathophysiological role, which also leads to a deficiency of antioxidants such as vitamin C. This perspective mini-review reflects the results of a PubMed search combining the search terms depression with inflammation, oxidative stress and vitamin C. Vitamin C is an important antioxidant and co-factor for many neuronal metabolic and epigenetic pathways, and a deficiency is associated with depression and cognitive disorders. Inadequate vitamin C blood levels that do not yet result in somatic symptoms may induce neuropsychiatric scurvy, which is associated with increased neuroinflammation and characterized by depression and cognitive impairment. Experimental studies show that vitamin C has multifactorial effects on metabolic pathways relevant to depression. Treatment of vitamin C deficiency, which is more common than appreciated, should be considered in the management of depressed patients. Further studies should investigate whether the pharmacological administration of vitamin C has additional effects beyond the correction of deficiency.

A patient with scurvy presented with malnutrition and generalised myalgia, bone pain, petechial rash, ecchymosis, gingival hypertrophy and bleeding, and an inability to walk. Initially, the petechial rash, arthralgia and bone pain posed a diagnostic challenge, with differential diagnoses including IgA vasculitis (Henoch–Schönlein purpura, HSP) and leukaemia. However, the rash was not typical of HSP, and there were no pathological blood smear findings. Vitamin C levels in the plasma were prioritised before conducting further investigations, including bone marrow aspiration and skin biopsy. Laboratory and radiological findings confirmed undetectable vitamin C levels in the plasma, and other results were compatible with scurvy and malnutrition. Notably, the erythrocyte sedimentation rate was elevated. The cause of multivitamin deficiency and malnutrition was investigated, and coeliac disease was identified. Scurvy in patients with coeliac disease is very rarely reported. The aim of this article is to draw attention to the importance of assessing and managing the dietary habits of school-age children, and, if necessary, further investigation for coeliac disease, and to highlight that scurvy can mimic HSP. ESR: erythrocyte sedimentation rate; Hb: haemoglobin; HSP: Henoch–Schönlein purpura; WCC: white-cell count. [ABSTRACT FROM AUTHOR]

Background: Scurvy has been a rare condition in the developed world due to the increasing availability of adequate nutrition and easy access to fruits and vegetables. Scurvy is caused by severe vitamin C deficiency and has been historically associated with malnutrition in high-risk populations such as sailors. As it is an uncommon nutritional deficiency, scurvy is seldom suspected and usually under-diagnosed especially in the pediatric population. Case presentation: We report a case of a pediatric patient with a history of autism spectrum disorder presenting with atypical symptoms of scurvy with gait abnormalities, diffuse rash, musculoskeletal deconditioning, and bleeding manifestations. After multiple extensive investigations and a prolonged hospitalization, a detailed dietary analysis revealed a severely restricted diet devoid of fruits and vegetables. Physical examination revealed specific signs of corkscrew hair with peri-follicular hemorrhages, hypertrophic, and bleeding gums with a concurrent low vitamin C level. Treatment with vitamin C supplementation was initiated and he was ambulant within 1 month of discharge. Conclusion: This case highlights the importance of nutrition history for determining micronutrient deficiency in children with special needs. Enhanced physician education and higher index of suspicion regarding nutritional deficiencies will avoid over-investigations and delays for the institution of specific treatment. [ABSTRACT FROM AUTHOR]

The paediatric metaphysis is afflicted by a wide range of pathological processes as it is the most metabolically active and well-vascularised part of the developing skeleton. This review focuses on metaphyseal marrow signal change detected with magnetic resonance imaging, which is most often occult on radiographs. When bilateral, these imaging appearances frequently present a diagnostic quandary. This review assists the radiologist to confidently dismiss physiological signal change and confidently work through the differential diagnosis. This is achieved by illustrating a practical method of classifying signal change into four categories: physiological red marrow, red marrow reconversion, marrow infiltration, and oedema-like marrow signal intensity. In doing so, various pathological entities are reviewed along with imaging pearls and next-step investigations. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion We aimed to investigate the frequency of vitamin C deficiency scurvy in the Australian paediatric context, describe cohorts at risk, and identify factors associated with development of symptoms in children with vitamin C deficiency. We also aimed to propose a management guideline for children with features of scurvy.A retrospective study was done at a tertiary paediatric hospital in Australia over a three‐year period, from August 2019 to July 2022. Children from birth to 18 years old, whose vitamin C levels were low (<23 μmol/L), were included. Data extracted from hospital medical records included demographics, weight, co‐morbidities, eating disorder diagnoses, clinical features, investigations and treatment. Descriptive statistics and risk statistics were performed.In a cohort of 887 patients who had their vitamin C levels checked, we identified 272 (31%) who had a vitamin C level <23 μmol/L. Of these, 13 (5%) were symptomatic of vitamin C deficiency and 19 (7%) may have been symptomatic. In patients with vitamin C deficiency, 248 (91%) had comorbidities, neurodevelopmental disorders being most common, and 176 (65%) had restricted eating. When the asymptomatic and symptomatic groups were compared, in the symptomatic group, there was a significantly lower vitamin C level and disordered eating related to autism spectrum disorders was more common.In order to avoid delayed diagnoses and unnecessary investigations, clinicians should be familiar with symptoms of scurvy and perform a dietary assessment, vitamin C assay, and commence empiric vitamin C supplementation where appropriate. [ABSTRACT FROM AUTHOR]

Jacques Cartier (1491-1557) reports, in the account of his second voyage to Canada in 1535-1536, that his crew was afflicted with a "grosse maladie" (scurvy) as well as other diseases, including a case of "grosse verolle" (syphilis), but was cured thanks to herbal teas made with the leaves of a tree called annedda, and in only six days. Until now, research on the annedda episode in the récit du deuxième voyage de Cartier has focused essentially on the nature of the "grosse maladie", on the identification of the plant called annedda, as well as its potential therapeutic virtues. This study aims to show that this episode must be understood in the context of Europe at the turn of the sixteenth century. It will see how the European imagination of the New World, as well as the medical context, notably the severe epidemic of syphilis prevalent at the time in Europe, may have influenced Cartier in the account he made to the king of his voyage. [ABSTRACT FROM AUTHOR]

In this paper we test a long-held assumption regarding Otago, New Zealand, goldfields life and death- that scurvy was a ubiquitous and persistent cause of misery and death among the goldminers. We will also explore a parallel argument that the Chinese market gardeners played a large role in stamping out the disease in the goldfields. Through the interrogation of various archival medical primary sources, we show that scurvy was indeed a terrible scourge in the Otago goldfields, but only during the initial rushes into new regions. We also argue that while Chinese market gardeners undoubtedly contributed to a more nutritious and varied diet for European miners and settlers, scurvy had already markedly reduced in frequency by the time of their arrival in the gold fields. Patient-oriented accounts of scurvy in the gold demonstrate the clinical and functional cost of scurvy in during the initial gold rushes of Otago. Furthermore, individual stories of previously anonymous patients found locked in these archival sources demonstrate the importance of re-humanising the past to understand the biological and social context of these frontier times. [ABSTRACT FROM AUTHOR]

This research aims to determine the aetiology of porosity and subperiosteal new bone formation on the inferior surface of the pars basilaris. A total of 199 non-adult individuals aged 36 weeks gestation to 3.5 years, from a total of 12 archaeological sites throughout the UK, including Iron Age (n=43), Roman (n=12), and post-medieval (n=145) sites, with a preserved pars basilaris. The pars basilaris was divided into six segments, with porosity (micro and macro) and subperiosteal new bone formation recorded on the inferior surface in scorbutic and non-scorbutic individuals. Scurvy was diagnosed using criteria from the palaeopathological literature that was developed using a biological approach. There was no statistically significant difference in microporosity between scorbutic and non-scorbutic individuals in four out of the six segments analysed. There was a significant negative correlation between age and microporosity in non-scorbutic and scorbutic individuals. A significant difference in subperiosteal new bone formation was observed between scorbutic and non-scorbutic individuals. Microporosity on the inferior pars basilaris should not be considered among the suite of lesions included in the macroscopic assessment of scurvy in non-adult skeletal remains (less than 3.5 years). This study highlights the risk of over diagnosing scurvy in past populations. It is difficult to distinguish between physiological (normal) and pathological (abnormal) bone changes in the skeleton of individuals less than one year of age. Future research should focus on the analysis of individuals over 3.5 years of age. [ABSTRACT FROM AUTHOR]

This study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria. 86 non-adult individuals were assessed from three early medieval sites. Morphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20–40x magnification. A significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults. In this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy. This study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process. Poor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth. Future applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies. [ABSTRACT FROM AUTHOR]

Scurvy, a rare disease resulting from vitamin C deficiency, can occur in individuals with restrictive eating disorders like anorexia nervosa (AN), leading to severe health complications. This review explores the complex relationship between scurvy and AN, highlighting the overlapping symptoms and challenges in diagnosis and treatment. Vitamin C is essential for collagen synthesis, immune function, and neurotransmitter production, and its deficiency manifests as fatigue, gingival bleeding, joint pain, and perifollicular hemorrhages. AN exacerbates these symptoms through extreme food restriction, causing severe nutritional deficiencies. Analyzing nine case reports, this review reveals that patients with co-occurring AN and scurvy often present with gastrointestinal, psychiatric, and dermatological symptoms. Treatment with vitamin C supplementation typically results in rapid symptom improvement. However, the malnutrition inherent in AN complicates the clinical picture, making timely diagnosis and intervention crucial. This review underscores the importance of a comprehensive, multidisciplinary approach to managing these conditions, emphasizing the need for early recognition and treatment to prevent severe complications. Future research should include a more diverse patient population to enhance understanding of the interplay between AN and scurvy, aiming to improve patient outcomes through tailored treatment strategies.

The article presents a case study of a 6-year-old child diagnosed with scurvy, evidenced by oral manifestations such as gingival overgrowth and palatal ecchymosis. Topics discussed include the patient's medical history, the role of vitamin C deficiency in the condition, and the effective treatment regimen involving vitamin C supplementation that led to a significant improvement in the child's symptoms.

The article describes trends in pediatric scurvy hospitalizations from 2006 to 2021 using the Pediatric Health Information System (PHIS) database. Topics discussed include increase in scurvy hospitalizations after 2017, median length of stay and median cost of admission, and possible factors for the rise in hospitalizations for pediatric scurvy.

Abstract Background Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children. Case presentation We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy. Conclusion Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential. Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role.

Background: Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children. Case presentation: We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy. Conclusion: Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential. Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role. [ABSTRACT FROM AUTHOR]

Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well. [ABSTRACT FROM AUTHOR]

l -Ascorbic acid (AsA) is an antioxidant with important roles in plant stress physiology, growth, and development. AsA also plays an essential role in human health, preventing scurvy. Humans do not synthesize AsA, which needs to be supplied via a diet rich in fresh produce. Research efforts have provided progress in the elucidation of a complex metabolic network with at least four routes leading to AsA formation in plants. In this review, three alternative pathways, namely the d -galacturonate, the l -gulose, and the myo -inositol pathways, are presented with the supporting evidence of their operation in multiple plant species. We critically discuss feeding studies using precursors and their conversion to AsA in plant organs, and research where the expression of key genes encoding enzymes involved in the alternative pathways showed >100% AsA content increase in the transgenics and in many cases accompanied by enhanced tolerance to multiple stresses. We propose that the alternative pathways are vital in AsA production in response to stressful conditions and to compensate in cases where the flux through the d -mannose/ l -galactose pathway is reduced. The genes and enzymes that have been characterized so far in these alternative pathways represent important tools that are being used to develop more climate-tolerant crops. [ABSTRACT FROM AUTHOR]

Scurvy is a nutritional disease caused by ascorbic acid (vitamin C) deficiency. Althought currently it is a rare disease, we should considerer it in the differential diagnosis of purpura and arthritis in patients with restrictive diets. We present the case of a 49-year-old man with a history of a nutritional disorder presented to our hospital with generalized purpura and hemarthros. Following the anamnesis and laboratory findings, rheumatological, infectious and hematological etiologies were excluded. Finally, the diagnosis of scurvy was made upon demostration poor levels of vitamin C and a spectacular response to nutritional supplements. We compare this case with 19 similar cases reported in the medical literature. [ABSTRACT FROM AUTHOR]

Water-soluble vitamins play an essential coenzyme role in the nervous system. Acquired vitamin deficiencies are easily treatable, however, without treatment, they can lead to irreversible complications. This study aimed to provide clinical, laboratory parameters and neuroimaging data on vitamin deficiencies in an attempt to facilitate early diagnosis and prompt supplementation. From July 1998 to July 2023, patients at Necker-Enfants-Malades Hospital presenting with acute neurological symptoms attributed to acquired vitamin deficiency were included. Clinical data were extracted from Dr Warehouse database. Neuroimaging, biochemical and electrophysiological data were reviewed. Patients with vitamin B1 deficiency exhibited abnormal eye movements (n = 4/4), fluctuations in consciousness (n = 3/4), and ataxia (n = 3/4). Brain MRI showed alterations of fourth ventricle region (n = 4/4), periaqueductal region (n = 4/4), tectum (n = 3/4), and median thalami (n = 3/4). Patients with vitamin B2 deficiency presented with early onset hypotonia (n = 3/4), hyperlactatemia (n = 4/4), and hyperammonemia (n = 4/4). Plasma acylcarnitines revealed a multiple acyl-coA dehydrogenase deficiency-like profile (n = 4/4). In vitamin B12 deficiency, young children presented with developmental delay (n = 7/7) and older children with proprioceptive ataxia (n = 3/3). Brain MRI revealed atrophy (n = 7/7) and spinal MRI hyperintensity in posterior cervical columns (n = 3/3). Metabolic findings showed elevated methylmalonic acid (n = 6/7) and hyperhomocysteinemia (n = 6/7). Patients with vitamin C deficiency exhibited gait disturbances and muscle weakness (n = 2/2). Acquired vitamin deficiencies may display reversible clinical symptoms mimicking inherited metabolic disorders. Some situations raise suspicion for diagnosis: concordant clinical presentation, suggestive neuroimaging findings, and/or biochemical evidence. Any acute neurological condition should be treated without waiting for definitive biochemical confirmation. • Although they are not extensively documented, vitamin deficiencies do occur in children. • Acquired vitamin deficiencies are easily treatable but without treatment, can lead to irreversible neurological complications. • One should consider a vitamin deficiency in the presence of unexplained neurological symptoms. • One should consider a vitamin deficiency in an exclusively breastfed infant showing signs of developmental stagnation. • Initiation vitamin supplementation should not be delayed pending conclusive biochemical confirmation. [ABSTRACT FROM AUTHOR]

Introduction: Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness's sake. Methods: We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the mid-Eastern United States. Presenting signs and symptoms, known scurvy risk factors, Vitamin C levels, clinical course, and outcome for each patient are described. Results: There were 14 presentations by 12 patients diagnosed with scurvy who were initially evaluated in the ED between 1993 and 2023. Each patient had a known risk factor for inadequate Vitamin C intake. All had clinical findings suggestive of scurvy and all but one had a subnormal serum Vitamin C level detected on serum samples sent from the ED. Conclusion: The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies. [ABSTRACT FROM AUTHOR]

Background: In the early literature, unintentional vitamin C deficiency in humans was associated with heart failure. Experimental vitamin C deficiency in guinea pigs caused enlargement of the heart. The purpose of this study was to collect and analyze case reports on vitamin C and pulmonary hypertension. Methods: We searched Pubmed and Scopus for case studies in which vitamin C deficiency was considered to be the cause of pulmonary hypertension. We selected reports in which pulmonary hypertension was diagnosed by echocardiography or catheterization, for any age, sex, or dosage of vitamin C. We extracted quantitative data for our analysis. We used the mean pulmonary artery pressure (mPAP) as the outcome of primary interest. Results: We identified 32 case reports, 21 of which were published in the last 5 years. Dyspnea was reported in 69%, edema in 53% and fatigue in 28% of the patients. Vitamin C plasma levels, measured in 27 cases, were undetectable in 24 and very low in 3 cases. Diet was poor in 30 cases and 17 cases had neuropsychiatric disorders. Right ventricular enlargement was reported in 24 cases. During periods of vitamin C deficiency, the median mPAP was 48 mmHg (range 29–77 mmHg; N = 28). After the start of vitamin C administration, the median mPAP was 20 mmHg (range 12–33 mmHg; N = 18). For the latter 18 cases, mPAP was 2.4-fold (median) higher during vitamin C deficiency. Pulmonary vascular resistance (PVR) during vitamin C deficiency was reported for 9 cases, ranging from 4.1 to 41 Wood units. PVR was 9-fold (median; N = 5) higher during vitamin C deficiency than during vitamin C administration. In 8 cases, there was direct evidence that the cases were pulmonary artery hypertension (PAH). Probably the majority of the remaining cases were also PAH. Conclusions: The cases analyzed in our study indicate that pulmonary hypertension can be one explanation for the reported heart failure of scurvy patients in the early literature. It would seem sensible to measure plasma vitamin C levels of patients with PH and examine the effects of vitamin C administration. [ABSTRACT FROM AUTHOR]

This paper presents evidence for hypomineralization disorders (rickets and osteomalacia) in non‐adults at Man Bac, a Neolithic site from northern Vietnam dated to 4000–3500BP, contributing to the well‐described disease burden at the site that includes scurvy, treponemal disease, thalassemia, and malaria. Forty‐four non‐adults (<20 years of age‐at‐death) were assessed for macroscopic and radiographic evidence for hypomineralization disorders. Differential diagnosis was completed using traditional methods and three‐level standardized criteria to combat the challenges of overlapping pathological features between hypomineralization disorder and the other diseases already diagnosed at the site. In addition, a diagnostic certainty approach was applied to investigate the impact of lesion ambiguity on our findings. Kaplan–Meier and Fishers exact tests were applied to assess age‐at‐death‐related epidemiological patterns of hypomineralization disorder and co‐morbid relationships with scurvy, thalassemia, and treponemal disease. Almost 50% of the non‐adult assemblage presented with evidence for hypomineralization disorder, which was associated with decreased survivorship in childhood. Potential epidemiological relationships between scurvy and hypomineralization disorders, and thalassemia and hypomineralization disorders are described. The former relationship may be due to the likelihood of the introduction of rice resulting in multi‐micronutrient deficiency, including vitamin C and calcium deficiency, and cultural attitudes to sunlight. The latter relationship may relate to the pathophysiology of thalassemia that can result in secondary osteomalacia possibly contributing to the development of hypomineralization disorder in the thalassemic non‐adults. The findings are significant as they present possible approaches for diagnosis of disease embedded within complex disease burdens where individuals are likely suffering from co‐morbidities. [ABSTRACT FROM AUTHOR]

Introduction: Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness’s sake. Methods: We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the mid-Eastern United States. Presenting signs and symptoms, known scurvy risk factors, Vitamin C levels, clinical course, and outcome for each patient are described. Results: There were 14 presentations by 12 patients diagnosed with scurvy who were initially evaluated in the ED between 1993 and 2023. Each patient had a known risk factor for inadequate Vitamin C intake. All had clinical findings suggestive of scurvy and all but one had a subnormal serum Vitamin C level detected on serum samples sent from the ED. Conclusion: The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies.

Abstract Background Scurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described. Case presentation A 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma. Conclusion DVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy.

Abstract Background Severe pulmonary hypertension (PH) in childhood is rare and can manifest as a life-threatening episode. We present 2 children with restrictive dietary habits with severe pulmonary hypertension secondary to scurvy and iron deficiency anemia with treatment and outcome. Case presentation The first case is a 2-year-old boy who presented with vomiting, diarrhea, and fever. After rehydration, he had recurrent episodes of hypotension with intermittent abdominal pain. Fluid resuscitation and inotropic medication were given. Then he suddenly collapsed. After 4-min cardiopulmonary resuscitation, his hemodynamic was stabilized. Most of the medical workup was unremarkable except for PH from the echocardiogram with estimated systolic pulmonary artery pressure (PAP) at 67 mmHg. Transient PH was diagnosed, and milrinone was prescribed. Since he had restrictive dietary habits and sclerotic rim at epiphysis in chest films, his vitamin C level was tested and reported low-level result. The second case is a 6-year-old boy with acute dyspnea, a month of low-grade fever, mild cyanosis, and a swollen left knee. Echocardiogram indicated moderate TR with estimated systolic PAP at 56 mmHg (systolic blood pressure 90 mmHg). Milrinone was given. Right cardiac catheterization showed PAP 66/38 (mean 50) mmHg and PVRi 5.7 WU.m2. Other medical conditions causing PH were excluded. With a history of improper dietary intake and clinical suspicion of scurvy, vitamin C was tested and reported undetectable level. Administration of vitamin C in both cases rapidly reversed pulmonary hypertension. Conclusion Pediatric PH related to vitamin C deficiency can manifest with a wide range of symptoms, varying from mild and nonspecific to severe life-threatening episodes characterized by pulmonary hypertensive crises. PH associated with scurvy is entirely reversible with appropriate investigation, diagnosis, and treatment. Our report highlights the importance of considering nutritional deficiencies as potential confounding factors in pediatric PH, emphasizing the need for comprehensive evaluation and management of these patients.

Ashagrachew Haile,1,&ast; Simeon Mara,1,&ast; Yegzeru Belete,2,&ast; Tesfa Dejene2 1Department of Internal Medicine, College of Medicine and Other Health Sciences, Hawassa University, Hawassa, Ethiopia; 2School of Medicine, College of Medicine and other Health Sciences, Hawassa University, Hawassa, Ethiopia&ast;These authors contributed equally to this workCorrespondence: Yegzeru Belete, Email ybtmeat.1@gmail.comBackground: Dietary deficiencies in vitamin C lead to scurvy, an uncommon disease of nutritional deficiency in contemporary clinical practice. The inability of humans to synthesize vitamin C necessitates the regular consumption of vitamin C containing fruits, vegetables, or tablets.Objective: To report a series of cases that came to HUCSH from May 25th up to the 18th of July, 2023, and to describe clinical features of scurvy from an observational study of on-site prison investigation.Methods: A descriptive analysis of a case series of ten patients admitted to HUCSH between May 25th and July 18th, 2023, and on-site observational study of 67 patients over one month. A structured questionnaire was used to collect data, and SPSS version 25 was used for analysis.Results: From the case series, all of the ten patients had either unilateral or bilateral leg swelling or pain as common compliant and all of them were male prisoners with mean age of 25.6± 5.33 years and following admission, the hemoglobin value increased to 7.1± 1.34 g/dL with treatment from 4.6± 1.88 g/dL. From observational study of the prison, 67 cases were identified based on unilateral or bilateral leg swelling and/or pain, which was the presenting feature in the cluster of cases seen at HUCSH. The mean age was 23.57± 6.4 years, and each patient got therapeutic doses of ascorbic acid 500mg PO daily using directly observed therapy and follow-up visit was after two and four weeks of ascorbic acid initiation and all patients showed significant improvement.Conclusion: For clinicians in modern medicine, there should be a high index of suspicion for scurvy as a possible differential diagnosis when a patient presents with leg swelling in high-risk population, such as prisoners. Health-care providers in prison clinics need to be alert to such forgotten yet life-costly disease in resource constrained prison clinics.Keywords: anemia, prison, scurvy, vitamin C, vitamin deficiency

Background: Scurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described. Case presentation: A 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma. Conclusion: DVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy. [ABSTRACT FROM AUTHOR]

Background: Spondylodiscitis can be a disabling and life‐threatening infection. Ascorbic Acid is crucial for neutrophil function and collagen formation. Its association and clinical relevance in spondylodiscitis has not been previously examined. Aims: To determine the prevalence, characteristics, and clinical outcomes of spondylodiscitis patients with Ascorbic Acid deficiency. Methods: Sixty‐eight consecutive patients admitted with spondylodiscitis, between December 2021 and August 2023 were included. Clinical characteristics, Ascorbic Acid levels and clinical outcomes were evaluated. Results: Thirty‐seven patients had Ascorbic Acid levels taken during admission. The median initial Ascorbic Acid level was 15 μmol/L with an IQR 6.5–27 μmol/L. Depletion defined as <28 μmol/L was present in 78% of patients. Deficiency defined as ≤11 μmol/L was present in and 46% of patients. Patients with depletion were more likely to require Intensive Care Admission (absolute risk increase = 24.1%; 2.6%–45.7%). Fifteen patients had repeat serum levels taken during admission with median increase of 17 μmol/L and an IQR 0–26 μmol/L. Patients that received supplementation had a significantly greater increase in Ascorbic Acid levels compared with those that did not receive supplementation (P = 0.002). Conclusion: Ascorbic acid deficiency is highly prevalent amongst spondylodiscitis patients. Depletion was associated with worse outcomes. Replacement significantly increased serum levels in comparison to standard hospital diet. The clinical significance of replacement remains to be evaluated. [ABSTRACT FROM AUTHOR]