Review
Scurvy: historical review and current diagnostic approach

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Abstract

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.

Section snippets

Case presentation

A 79-year-old black woman presented to the ED of an inner-city community hospital. Her brother provided most of the history; however, the patient also answered simple questions appropriately. Her chief complaint was the development of increasing pain and ecchymoses in her ankles over a 72-hour timeframe to the point that she could not walk. The left side was more symptomatic than the right. She did not have a history of trauma, overuse, or other precipitating events.

The patient admitted to

History of scurvy

Scurvy is an ancient disease, taking its place among the most dreaded and devastating plagues of history. It was first described in the Ebers papyrus, written approximately 1500 BC.5 Seeing whole groups of people in monasteries, within families, aboard ships, and in armies afflicted with the disease, ancient writers developed multiple and varying theories regarding its etiology. Infectious, genetic, environmental, toxic, and dietary causes were proposed. Herman Boerhaave attributed scurvy to a

Conclusion

Scurvy, while dreaded and fatal in earlier eras, need no longer be feared. The capillary fragility of scurvy leads to the classic symptoms of purpuric lesions, joint pain, and bleeding gums. It is important for the EP to include scurvy in the differential diagnosis of patients who present with these symptoms. Appropriate diagnosis and treatment is life saving, even when patients present in the most advanced stages.

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