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Be vigilant for scurvy in high-risk groups.
Practitioner 2012; 256(1755):23-5, 3P

Abstract

Scurvy is caused by prolonged dietary deficiency of vitamin C, the plasma concentration of which appears inversely related to mortality from all causes. Its clinical importance relates principally to its role as a cofactor in a number of enzyme reactions involved in collagen synthesis, dysfunction of which disrupts connective tissue integrity, resulting in impaired wound healing and capillary bleeding. In the UK, overt scurvy is diagnosed only rarely. However, subclinical vitamin C deficiency appears quite common, one study estimated that 25% of men and 16% of women in the low income/materially deprived population had vitamin C deficiency, with smoking a strong predictor. Because many of the early symptoms of vitamin C deficiency (fatigue, malaise, depression and irritability) are non-specific, the diagnostic possibility of scurvy is usually delayed until haemorrhagic manifestations occur. The classical cutaneous features consist of perifollicular purpura, contorted (corkscrew) hairs and follicular hyperkeratosis, particularly affecting the legs. Large areas of purpura or ecchymosis may occur. Swelling and bleeding of the gums is an early mucosal symptom, and progressively severe gum disease causes loss of teeth. Subperiosteal haemorrhage, particularly in the femur and tibia, can present as pain, pseudoparalysis, swelling and discoloration of the legs. Haemorrhage into joints and muscle is very uncomfortable. Diagnosis is generally made on the basis of clinical features, corroborated by a history of dietary inadequacy, and the subsequent rapid resolution of symptoms with the restoration of an adequate vitamin C intake.

Authors+Show Affiliations

Addenbrooke's Hospital, Cambridge, UK.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23214273

Citation

Ben-Zvi, Galia T., and Michael J. Tidman. "Be Vigilant for Scurvy in High-risk Groups." The Practitioner, vol. 256, no. 1755, 2012, pp. 23-5, 3.
Ben-Zvi GT, Tidman MJ. Be vigilant for scurvy in high-risk groups. Practitioner. 2012;256(1755):23-5, 3.
Ben-Zvi, G. T., & Tidman, M. J. (2012). Be vigilant for scurvy in high-risk groups. The Practitioner, 256(1755), pp. 23-5, 3.
Ben-Zvi GT, Tidman MJ. Be Vigilant for Scurvy in High-risk Groups. Practitioner. 2012;256(1755):23-5, 3. PubMed PMID: 23214273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Be vigilant for scurvy in high-risk groups. AU - Ben-Zvi,Galia T, AU - Tidman,Michael J, PY - 2012/12/11/entrez PY - 2012/12/12/pubmed PY - 2013/1/9/medline SP - 23-5, 3 JF - The Practitioner JO - Practitioner VL - 256 IS - 1755 N2 - Scurvy is caused by prolonged dietary deficiency of vitamin C, the plasma concentration of which appears inversely related to mortality from all causes. Its clinical importance relates principally to its role as a cofactor in a number of enzyme reactions involved in collagen synthesis, dysfunction of which disrupts connective tissue integrity, resulting in impaired wound healing and capillary bleeding. In the UK, overt scurvy is diagnosed only rarely. However, subclinical vitamin C deficiency appears quite common, one study estimated that 25% of men and 16% of women in the low income/materially deprived population had vitamin C deficiency, with smoking a strong predictor. Because many of the early symptoms of vitamin C deficiency (fatigue, malaise, depression and irritability) are non-specific, the diagnostic possibility of scurvy is usually delayed until haemorrhagic manifestations occur. The classical cutaneous features consist of perifollicular purpura, contorted (corkscrew) hairs and follicular hyperkeratosis, particularly affecting the legs. Large areas of purpura or ecchymosis may occur. Swelling and bleeding of the gums is an early mucosal symptom, and progressively severe gum disease causes loss of teeth. Subperiosteal haemorrhage, particularly in the femur and tibia, can present as pain, pseudoparalysis, swelling and discoloration of the legs. Haemorrhage into joints and muscle is very uncomfortable. Diagnosis is generally made on the basis of clinical features, corroborated by a history of dietary inadequacy, and the subsequent rapid resolution of symptoms with the restoration of an adequate vitamin C intake. SN - 0032-6518 UR - https://www.unboundmedicine.com/medline/citation/23214273/Be_vigilant_for_scurvy_in_high_risk_groups_ L2 - http://www.diseaseinfosearch.org/result/6471 DB - PRIME DP - Unbound Medicine ER -