Scurvy, also known as vitamin C deficiency, is not solely a historical ailment confined to 18th-century sailors, as illustrated by a case involving a 65-year-old woman with limited mobility and social isolation. This case is detailed in an article published in the Canadian Medical Association Journal (CMAJ), found at CMAJ. Medical professionals highlight the importance of considering scurvy as a possible diagnosis in patients who exhibit abnormal bleeding and nonspecific symptoms.
The individual in question sought medical help at an emergency department in a downtown Toronto hospital, presenting with symptoms such as leg pain and weakness, skin lesions, and discolouration. Her medical history included several chronic health conditions, and her physical disabilities severely limited her ability to shop for groceries, cook, and carry out other daily tasks. With minimal external support, her diet primarily consisted of canned soup and fish, devoid of fresh fruits or vegetables.
Dr. Sarah Engelhart, a general internist at Mount Sinai Hospital and the University of Toronto, expressed that this case exemplifies the complex nature of food insecurity leading to rare diagnoses. A comprehensive evaluation of the patient’s social and dietary history was crucial in reaching a conclusive diagnosis.
Despite common perceptions, vitamin C deficiency remains surprisingly prevalent in the modern era. In the United States, about 5.9% of the population is affected, and in certain socioeconomically disadvantaged groups in the United Kingdom, the rate may reach as high as 25%.
The challenge in diagnosing vitamin C deficiency is its vague symptoms, including fatigue, weakness, and shortness of breath. The patient’s smoking habit further exacerbated her deficiency. Following the initiation of vitamin C therapy, her symptoms improved significantly, and a subsequent blood test confirmed the deficiency.
Medical professionals are advised to remain vigilant for signs of vitamin C deficiency when evaluating patients, particularly among vulnerable groups such as children, elderly individuals living in isolation, those with restrictive eating habits like those seen in autism spectrum disorder or individuals subsisting on a ‘tea and toast’ diet, smokers, substance users, or those suffering from malabsorption syndromes. The study’s authors stress the importance of being aware of food insecurity, a significant risk factor that impacts approximately one in five Canadian households.
More information: Kevin R. Murray et al, Scurvy in a 65-year-old woman with severely limited function and social supports, Canadian Medical Association Journal. DOI: 10.1503/cmaj.240769
Journal information: Canadian Medical Association Journal
