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Infantile scurvy: an old diagnosis revisited with a modern dietary
twist.
Am J Clin Dermatol.
2007;8(2):103-6.
Ascorbic acid
(vitamin C) is necessary for the formation of collagen, reducing free
radicals, and aiding in iron absorption. Scurvy, a disease of dietary
ascorbic acid deficiency, is uncommon today. Indeed, implementation of
dietary recommendations largely eradicated infantile scurvy in the US
in the early 1900s. We present a case of an otherwise healthy
2-year-old Caucasian girl who presented with refusal to walk secondary
to pain in her lower extremities, generalized irritability, sleep
disturbance, and malaise. The girl's parents described feeding the
patient an organic diet recommended by the Church of Scientology that
included a boiled mixture of organic whole milk, barley, and corn
syrup devoid of fruits and vegetables. Physical examination revealed
pale, bloated skin with edematous, violaceous gums and loosening of a
few of her teeth. Dermatologic findings included xerosis, multiple
scattered ecchymoses of the extremities, and perifollicular
hemorrhage. Laboratory and radiographic evaluation confirmed the
diagnosis of scurvy. The patient showed dramatic improvement after
only 3 days of treatment with oral ascorbic acid and significant
dietary modification. In this case report, we revisit the old
diagnosis of scurvy with a modern dietary twist secondary to religious
practices. This case highlights the importance of taking a detailed
dietary history when evaluating diseases involving the skin.
Vitamin C
measurements in vulnerable populations: 4 cases of scurvy.Ann
Biol Clin (Paris). 2007
Jan-Feb;65(1):65-9.
Hypovitaminose
C, at the origin of the scurvy, did not disappear. We report 4 cases
of desocialized patients and whose very unbalanced diet was at the
origin of the vitamin deficit. In addition to the hemorrhagic
demonstrations described among 4 patients, one finds a modification of
the superficial body growths. Physiologically, the vitamin C takes
part in the stability of the collagen of the vascular wall and the
bone. The biological assessment of the 4 patients was normal apart
from the low ascorbemy, a syndrome of denutrition and anaemia related
to the haemorrhage. The quality of the vitamin C determination
requires to respect the recommended pre-analytical conditions. The
treatment quickly effective, consists of an oral administration of
ascorbic acid. The evolution for 3 of the 4 described patients was
favorable without after-effects. The proportioning of the vitamin C
should be more often prescribed in geriatrics, psychiatry and
cancerology. It should systematically form part of the biological
assessment of the people living alone and/or homelessness.
Vitamin C.
Actas Dermosifiliogr. 2006
Nov;97(9):557-68.
Vitamin C or
ascorbic acid is a hydrosoluble vitamin derived from glucose
metabolism. It acts as a reductor agent required for synthesis of
collagen fibers through hydroxylation of proline and lysine. It also
protects the body against damage caused by the free radicals. Humans
cannot synthesize ascorbic acid as they lack an enzyme called
gulonolactone oxidase. Concentrations in plasma and leukocytes reflect
the levels of the diet and body deposits respectively of this vitamin.
Among foods with high vitamin C levels are tomatoes, potatoes, and
citrus fruits such as limes, oranges and lemons. The current
recommendation of daily intake of vitamin C is 90 mg/d for men and 75
mg/d for women. Patients with chronic diseases such as cancer or
diabetes or those who smoke need higher doses in their usual diet.
Ascorbic acid deficiency gives rise to the appearance of scurvy. This
disease is rarely seen in developed countries. The symptoms develop
with plasma levels below 0.15 mg/dL. Scurvy is characterized by the
presence of weakness, joint pain or skin lesions in form of petechias,
gum bleeding, ease of developing bruises or delay in wound healing.
The most characteristic skin manifestations are purpuric
perifollicular hyperkeratotic papules and the presence of kinky hair.
Scurvy: a
disease almost forgotten.Int
J Dermatol. 2006 Aug;45(8):909-13.
BACKGROUND:
Although much decreased in prevalence, scurvy still exists in
industrialized societies. Few recent large studies have examined its
pathogenesis, signs, and symptoms. METHODS: After we diagnosed scurvy
in a 77-year-old female patient in 2003, we conducted a retrospective
records review to identify patients with scurvy treated between 1976
and 2002 at Mayo Clinic (Scottsdale, Arizona; Rochester, Minnesota; or
Jacksonville, Florida). We also searched the English-language medical
literature for published reports on scurvy. RESULTS: In addition to
our patient, seven of 11 patients whose records in the institutional
database mentioned vitamin C deficiency were women. The age ranged
from a neonate to 77 years (mean, 48 years). The most common
associated causes were concomitant gastrointestinal disease, poor
dentition, food faddism, and alcoholism. Vitamin or mineral
deficiencies other than vitamin C deficiency were also found in our
patients who had scurvy. The most common symptoms were bruising,
arthralgias, or joint swelling. The most common signs were pedal
edema, bruising, or mucosal changes. Four patients had vague symptoms
of myalgias and fatigue without classic findings, and five had
concomitant nutritional deficiencies. Follow-up available for six of
12 patients treated by vitamin C supplementation showed complete
resolution of symptoms in five. CONCLUSIONS: Patients with scurvy may
present with classic symptoms and signs or with nonspecific clinical
symptoms and an absence of diagnostically suggestive physical
findings. Concomitant deficiency states occur not uncommonly. Taking a
thorough dietary history and measuring serum ascorbic acid levels
should be considered for patients with classic signs and symptoms,
nonspecific musculoskeletal complaints, or other vitamin or mineral
deficiencies.
Is sudden
death with vitamin C deficiency caused by lack of carnitine?:
J Clin Forensic
Med. 2006 Jan;13(1):26-9.
We
investigated the effect of carnitine supplementation during vitamin C
(ASC) deficiency by measuring the levels of ASC and carnitine in
plasma and cardiac muscle cells (CMC), and histological analysis with
electron microscopy. The levels of carnitine were significantly
decreased in ASC-deficient rats in plasma and the heart than those in
the control. In carnitine supplemented ASC-deficient rats, a
significant increase of carnitine levels were observed in both plasma
and heart. The number of lipid droplets significantly increased in the
ASC-deficient rats compared to the control rats, but did not increase
in carnitine supplemented rats. These results indicate that ASC
deficiency causes a generalized mitochondrial abnormality and
accumulation of lipid droplets in CMC as observed in carnitine
deficiency, and supplementation of carnitine prevented these changes
even in the presence of ASC deficiency.
Scurvy:
follicular purpura as a diagnostic sign.
Actas Dermosifiliogr. 2005 Jul-Aug;96(6)
:400-2.
Scurvy is a
set of clinical manifestations characterized by general weakness,
anemia, gingivitis and cutaneous bleeding, caused by a lack of
ascorbic acid in the diet. This pathology is currently a clinical
rarity, although it can still be seen in cases of malnutrition
associated with alcoholism or with dietary deficiencies, especially in
childhood and old age. We present the case of a 45-year-old male who
consulted his physician because of lower limb edema with follicular
purpura, accompanied by asthenia, polyarthralgia and bleeding gums.
After treatment with 1 g/day of vitamin C was initiated, the patient's
symptoms quickly improved. The diagnosis of scurvy was based on the
patient's clinical symptoms, dietary history and the rapid resolution
of the symptoms when vitamin C supplements were initiated.
Musculoskeletal manifestations of scurvy.Joint
Bone Spine. 2005 Mar;72(2):124-8.
Scurvy occurs
in individuals who eat inadequate amounts of fresh fruit or
vegetables, often because of dietary imbalances related to advanced
age or homelessness. Asthenia, vascular purpura, bleeding, and gum
abnormalities are the main symptoms. In 80% of cases, the
manifestations of scurvy include musculoskeletal symptoms consisting
of arthralgia, myalgia, hemarthrosis, and muscular hematomas. Vitamin
C depletion is responsible for structural collagen alterations,
defective osteoid matrix formation, and increased bone resorption.
Imaging studies may show osteolysis, joint space loss, osteonecrosis,
osteopenia, and/or periosteal proliferation. Trabecular and cortical
osteoporosis is common. Children experience severe lower limb pain
related to subperiosteal bleeding. Laboratory tests show nonspecific
abnormalities including anemia and low levels of cholesterol and
albumin. The finding of a serum ascorbic acid level lower than 2.5
mg/l confirms the diagnosis. Vitamin C supplementation ensures prompt
resolution of the symptoms.
Vitamin C
deficiency.
Rev Med Interne. 2004 Dec;25(12):872-80.
BACKGROUND:
Hypovitaminosis C is frequent in populations at risk (men who live
alone, old people, homelessness, patients with psychiatric diseases,
foodfaddists,...) and is underestimated in the general population.
STRONG POINTS: Scurvy occurs after 3 months without consumption of
ascorbic acid, and is due to lack of consumption fresh fruits and
vegetables. Clinical manifestations are weakness, myalgia and
arthralgia, vascular purpura and hemorrhagic syndrome, and later the
stomatologic manifestations: gingivorragia and loss of teeth.
Biological signs are nonspecific: anemia, hypocholesterolemia,
hypoalbuminemia. Clinical suspicion must be confirmed by a low level
of ascorbic acid (<2.5 mg/l), but this value needs to be interpretated
according to the presence of an acute phase response. Leucocyte
ascorbic acid level reflects total body store and is more reliable,
but not available in practice. Treatment consists in administration of
1 g vitamin C per day during 15 days. PERSPECTIVES: Vitamin C
depletion (serum ascorbic acid level between 2 and 5 mg/l) may occur
long-term complications such as increase cardiovascular and neoplasic
risks or cataract. The new recommended dietary allowance of vitamin C
(110 mg per day for an adult) takes into account of these risks.
Scurvy:
historical review and current diagnostic approach.Am
J Emerg Med. 2003 Jul;21(4):328-32.
Scurvy, a
deficiency of vitamin C, now most often occurs in disadvantaged groups
seen frequently in EDs: alcoholics with poor nutrition, the isolated
elderly, and the institutionalized. Its prominent clinical features
are lethargy; purpuric lesions, especially affecting the legs; myalgia;
and, in advancing disease, bleeding from the gums with little
provocation. Common misdiagnoses are vasculitis, blood dyscrasias, and
ulcerative gingivitis. Untreated, scurvy is inevitably fatal as a
result of infection or sudden death. Fortunately, individuals with
scurvy, even those with advanced disease, respond favorably to
administration of vitamin C.
Vitamin C
and bone markers: investigations in a Gambian population.Proc
Nutr Soc. 2003 May;62(2):429-36.
Vitamin C is
an essential micronutrient. Absence from the diet will result in the
deficiency disease scurvy, typically characterised by weakening of
collagenous structures. High intakes of vitamin C have been associated
with decreased incidence or severity of a number of diseases,
including cancer and cardiovascular disease. These beneficial effects
may be attributed to its antioxidant properties, although the exact
mechanisms of action remain elusive. It is also unclear what intake
levels are required for optimal health benefits. The task of defining
optimal intakes is hindered by the lack of a reliable functional
marker of tissue vitamin C status in man. Many different pathways have
been investigated, but none of them have measurable outcome variables
relating directly to scorbutic changes. The bone-collagen formation
pathway has the potential to provide a functional index of tissue
vitamin C adequacy. Vitamin C acts as a cofactor for the enzyme lysyl
hydroxylase, which is required for the hydroxylation of lysine
residues in procollagen chains. Pyridinoline is a mature collagen
cross-link formed from three hydroxylysine residues, deoxypyridinoline
is formed from two hydroxylysine and one lysine residue. Guinea-pig
studies have shown an alteration in the pyridinium cross-link ratios
in response to graded vitamin C intakes (Tsuchiya & Bates, 1998). In
order to investigate whether these changes can be seen in a human
population group, a study was carried out in rural Gambia, where there
is a marked seasonal variation in dietary vitamin C. The present
review discusses the rationale behind the study and presents some
preliminary results.
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