ReviewScurvy: historical review and current diagnostic approach
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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