Recent case shows scurvy still a threat

Geneva, Switzerland - A case study reported in the Archives of Internal Medicine highlights that a condition such as scurvy could occur in patients who are not thought to be at high risk for developing the condition.

"Scurvy is already well known to occur in developed nations among certain populations, such as elderly people and alcoholics," according to Dr. Denis Jabaudon, M.D., Ph.D., a neurologist at the Geneva University Hospital.

He highlights the case of a 27-year-old man who worked as a manager at a McDonald's fast food restaurant and consumed anywhere from 10 to 15 L of caffeinated soft drink per day for three years. He also was a tobacco user, smoking a pack per day of cigarettes for six years, which, in itself, is associated with increased requirements for vitamin C.

"He had patches of lost hair on his head and looked tired and malnourished," Dr. Jabaudon says.

Surprising assessment Several blood tests for various vitamins confirmed the suspected clinical diagnosis, and the results of the vitamin assessment came as a surprise.

"We were really astonished by the extent to which vitamin C levels were decreased and by the fact that other vitamins were within the normal range," Dr. Jabaudon says, noting the patient was somewhat obese with a body mass index of 32.

"There were signs and symptoms of malnutrition, but we didn't expect that extent of vitamin C depletion. We were able to ascribe symptoms to this deficit."

Orthostatic hypotension, which the patient presented with, has occasionally been reported in patients with scurvy, perhaps because of the result of reduced norpepinephrine synthesis by a vitamin-C-dependent enzyme, Dr. Jabaudon says.

The patient was hospitalized for a week, was given vitamin supplementation and dietary counseling. Along with a lifestyle change, vitamin supplementation led to a rapid clearing of symptoms such as alopecia, bruising and bleeding gums.

Hypothesis "My hypothesis is that since he was drinking large amounts of something with high calorie content, it would fulfill his caloric needs, and he would not be hungry, so he would not seek other types of food," Dr. Jabaudon contends. "He indicated he was eating some bread, which was sufficient to provide him with other vitamins, but not vitamin C."

While Dr. Jabaudon did not find any direct link between caffeinated soft drink consumption and the development of hypovitaminosis C, he postulated that tobacco consumption left the patient vulnerable to developing the deficit. In addition to hypovitaminosis C, the patient also suffered from hypercholesterolemia, with his total serum cholesterol measuring 266.4 mg/dl.

"Tobacco smokers make use of their vitamin C faster than non-smokers, and therefore have higher daily requirements for this compound."

Western context Dermatologists would rarely see cases of scurvy in a Western context.

A review article published in the Journal of the American Academy of Dermatology in December 1999 notes that vitamin C treatment, on the order of 100 mg three times daily, will result in dramatic improvement in adult patients with scurvy. The article notes that hyperkeratosis or skin lesions that can develop with scurvy would resolve in weeks with adequate vitamin C supplementation. The only permanent damage may be lost teeth.

"The scientific interest of this isto say that scurvy can happen in a developed society, even among young people," Dr. Jabaudon says.