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TORONTO — Scurvy may be something many people probably think isn’t even real. That’s because you likely only hear about it in pirate movies and stories about ocean adventures from the 1700s! Well, it turns out that scurvy is very real and still affecting people in 2024.
A new study finds that this disease, associated with 18th-century sailors, can still pop up in society even if you’re not taking a long sea voyage. In fact, a recent investigation published in the Canadian Medical Association Journal has documented a case of scurvy in a 65-year-old woman battling mobility issues and social isolation.
The patients arrived at a hospital emergency room with progressively weakening legs and difficulty moving around. What initially seemed like a straightforward case of mobility problems soon unfolded into a complex medical mystery that highlighted the ongoing relevance of nutritional deficiencies in contemporary healthcare.
What Is Scurvy?
According to the Cleveland Clinic, scurvy is a disease resulting from serious vitamin C deficiency. Not eating enough fruits and vegetables is typically the main cause of the condition. Left untreated, the disease can lead to serious dental issues, including bleeding gums and loosened teeth. It can also cause bleeding under your skin.
The patient’s journey to diagnosis began with some peculiar symptoms. For about three months, she noticed unusual skin discoloration on both thighs. A telehealth consultation with her family doctor led to a misdiagnosis of a fungal infection, for which she was prescribed an antifungal cream that didn’t help. The real clues to her condition lay hidden in her lifestyle and diet.
Living alone with limited social support, researchers say the woman had been struggling for years with daily activities like grocery shopping and cooking due to her mobility issues. As a result, her diet had become severely restricted, consisting mainly of canned soups, tuna fish, white bread, and processed cheese. This limited menu, devoid of fresh produce, set the stage for a nutritional crisis.
After arriving at the hospital, doctors noticed several telltale signs: bruise-like patches on her skin, particularly in the groin area and upper legs, as well as small, reddish-purple spots around hair follicles on her lower legs. Perhaps most striking was the appearance of her gums, which were swollen and showed signs of bleeding.
These symptoms, combined with her dietary history, led the medical team to suspect an unusual culprit: vitamin C deficiency, also known by its centuries-old name, scurvy. This diagnosis was confirmed when blood tests revealed a virtually undetectable level of vitamin C in her system. Simply put, the patient had so little vitamin C in her body that it made her seriously ill.
Scurvy Is More Common Than You Think
Vitamin C deficiency is more common than you might expect in modern times. In the 21st century, researchers estimate that up to 5.9% of the United States population suffers from low vitamin C levels, putting them at risk for scurvy. The Canadian team adds that up to 25% of certain groups living in poor economic conditions in the United Kingdom face the same risk.
“This case presents a complex example of food insecurity manifesting as an uncommon diagnosis,” says Dr. Sarah Engelhart, a general internist at Mount Sinai Hospital and the University of Toronto, in a media release. “A unifying diagnosis was uncovered only after a detailed assessment of her social and dietary history.”
This new case serves as a stark reminder that even in developed countries, nutritional deficiencies can occur, especially among vulnerable populations. Factors such as limited mobility, social isolation, and food insecurity can create perfect conditions for scurvy to develop, even in the 21st century.
Treatment for the patient was straightforward once the diagnosis was made. She received high doses of vitamin C intravenously for a week, followed by oral supplements. Her symptoms began to improve, and she was eventually discharged to a rehabilitation facility with a plan for follow-up care.
While scurvy may seem like a relic of the past, this case reminds us that history can repeat itself in unexpected ways. It serves as a call to action for healthcare providers to remain vigilant about nutritional health and to consider the broader social context of their patients’ lives when making diagnoses.
Paper Summary
Methodology
The study was conducted as a case report, focusing on a single patient who presented to the emergency department with specific symptoms. The medical team performed a thorough physical examination and took a detailed medical and social history. They also conducted various laboratory tests, including blood work, to check vitamin levels and rule out other potential causes of the patient’s symptoms.
Key Results
The key finding was the patient’s undetectable level of vitamin C in her blood, which confirmed the diagnosis of scurvy. Other results included signs of anemia (low red blood cell count) and the presence of characteristic skin and gum changes associated with vitamin C deficiency.
Study Limitations
As a case study of a single patient, this report cannot be generalized to the broader population. It does not provide information on the prevalence of vitamin C deficiency in similar demographics or the general population.
Discussion & Takeaways
The authors emphasize the importance of considering nutritional deficiencies, particularly in patients with limited diets or social support. They suggest that healthcare providers should maintain a high index of suspicion for vitamin C deficiency, especially in patients with risk factors such as food insecurity, smoking, or restrictive eating patterns. The case also highlights the need for a holistic approach to patient care, considering social and economic factors that may impact health.
Funding & Disclosures
The paper does not mention any specific funding sources for this case report. The authors declared no competing interests related to the study.
