Scurvy, a condition caused by vitamin C deficiency was first linked to sailors during the Renaissance era.
Economic hardships and bariatric surgeries are leading to a re-emergence of scurvy.
Scurvy, a disease caused by vitamin C deficiency, may be making a comeback due to the rising cost of living and the increase in weight loss (bariatric) surgeries, according to doctors writing today (October 22) in BMJ Case Reports. This observation comes after they treated a middle-aged man who developed scurvy.
Although scurvy is easily treatable, it’s often overlooked because it’s seen as a disease of the past, historically linked to sailors during the Renaissance. This can lead to it being misdiagnosed as other conditions, such as vasculitis (inflammation of blood vessels), which could result in dangerous complications, including potentially fatal bleeding, if left untreated.
Symptoms of scurvy can start as soon as a month after consistently consuming less than 10 mg of vitamin C per day.
Diagnostic Challenges and Patient Symptoms
In this case, the doctors treated a man whose legs were covered with painful red-brown pinpoints that resembled a rash. He was also anemic and had blood in his urine.
He tested negative for inflammatory, autoimmune, and blood disorders, and scans revealed no evidence of internal bleeding. Similarly, a skin biopsy returned no diagnostic clues.
His rash continued to spread while he was in the hospital. Further questioning revealed that he was short of cash and neglected his diet, eating little in the way of fruit and vegetables. He said that he sometimes skipped meals altogether.
He had also stopped taking the nutritional supplements prescribed for him after previous weight loss surgery, because he said he couldn’t afford them.
Treatment and Broader Implications
Blood tests to assess his general nutritional status indicated no detectable levels of vitamin C and very low levels of other key nutrients. He was diagnosed with scurvy and treated with daily vitamin C (1000 mg), vitamin D3, folic acid, and multivitamin supplements, after which his painful rash and other symptoms cleared up.
This is just one case report, and while it’s not clear what the current prevalence of scurvy is, it’s still relatively rare.
But the authors point out: “Scurvy is still seen as a disease of the past, especially in developed countries.” The rising cost of living also makes it harder for families to afford good quality nutritious foods, while there have been numerous reports of scurvy arising from complications following bariatric surgery, they add.
Other risk factors for scurvy include alcoholism, smoking, eating disorders, low household income, obesity, kidney dialysis and drugs that interfere with vitamin C absorption, such as steroids and those that curb stomach acid production (proton pump inhibitors), they highlight.
“Our patient had multiple risk factors, namely, poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors, and low-income status. His history of iron, vitamin D, and folate deficiencies were also clues to his underlying nutritional deficiency,” they conclude.
Reference: “Scurvy—a re-emerging disease with the rising cost of living and number of bariatric surgical procedures” by Andrew Dermawan, Sehrina Eshon, Kevin Danagher and Sivanthi Senaratne, 1 August 2024, BMJ Case Reports CP.
DOI: 10.1136/bcr-2024-261082
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