Materiały źródłowe

• #1 Vitamin C Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493187/

  Vitamin C deficiency, commonly called scurvy, is a well-documented nutritional disorder with historical significance that continues to impact global health today. […] Classic signs of vitamin C deficiency include corkscrew hairs, perifollicular hemorrhages, and gingival bleeding. Scurvy is a rare and reversible condition that requires early diagnosis and treatment. […] This article defines the sources, metabolism, and functions of vitamin C, covering the diagnosis, physical manifestations, evaluation, treatment, prognosis, and prevention of vitamin C deficiency. […] Scurvy is diagnosed clinically through relevant medical history, physical examination observations, and a rapid response to vitamin C supplementation. […] A low plasma vitamin C level of less than 0.2 mg/dL may indicate scurvy, but chronic deficiency could be concealed.

• #2 Scurvy: Forgotten diagnosis, but still exist

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7082595/

  Scurvy is a rare condition in pediatric patients, resulted from a vitamin C deficiency. Musculoskeletal symptoms occur in 80% of patient. The rarity and the polymorphisms of the clinical signs and symptoms often make scurvy an unknown or forgotten diagnosis. […] Because of the extremely rare occurrence of scurvy in modern society at present, it is difficult to differentiate it from other diseases such as infection. The diagnosis of scurvy is made by careful studies from history taking, physical examination, laboratory and especially radiological finding that show pathognomonic appearance. Examination of vitamin C level serum is a gold standard, but unfortunately not available in our country. Improvement after vitamin C administration also established that condition. […] Scurvy should have established by clinical and radiological findings that show pathognomonic signs around joint, even without supported by vitamin C serum.

• #3

  https://journals.lww.com/onlinejets/fulltext/2024/17020/scurvy__a_rare_disease_or_a_rare_diagnosis_.2.aspx

  Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness sake. […] The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies. […] Scurvy is primarily a clinical diagnosis, supported by laboratory tests (serum ascorbic acid level, normal range, 0.6-2.0 mg/dL or 0.2-1.5 mg/dL depending upon the reference laboratory performing the test). […] I propose that if scurvy was entertained as a diagnosis at appropriate times, case reports would gradually be replaced by case series and a more accurate understanding of the prevalence of scurvy in modern societies would emerge.

• #4 Scurvy: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24318-scurvy

  Your healthcare provider can diagnose scurvy based on your symptoms. Theyll perform a physical examination and evaluate you based on certain risk factors for the condition. […] Your healthcare provider may request a blood test to measure the amount of vitamin C in your blood. In addition, they may perform a test called a dermoscopy. With this procedure, theyll take a sample of your affected skin or hair (biopsy) and examine it under a microscope. […] Scurvy treatment is essential to avoid further complications. The condition is easily treatable by consuming more vitamin C. You should try to maintain a nutritious diet that includes one to two times your daily recommended amount of vitamin C. You can do so by adding fresh fruits and vegetables to every meal. […] Most people feel better within 48 hours of treatment. You should be able to make a full recovery within two weeks. Some symptoms may take longer to fully clear up. Depending on the cause of your condition, your provider may refer you to a specialist for further treatment.

• #5 Vitamin C Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493187/

  Vitamin C deficiency, commonly called scurvy, is a well-documented nutritional disorder with historical significance that continues to impact global health today. […] Classic signs of vitamin C deficiency include corkscrew hairs, perifollicular hemorrhages, and gingival bleeding. Scurvy is a rare and reversible condition that requires early diagnosis and treatment. […] This article defines the sources, metabolism, and functions of vitamin C, covering the diagnosis, physical manifestations, evaluation, treatment, prognosis, and prevention of vitamin C deficiency. […] Scurvy is diagnosed clinically through relevant medical history, physical examination observations, and a rapid response to vitamin C supplementation. […] A low plasma vitamin C level of less than 0.2 mg/dL may indicate scurvy, but chronic deficiency could be concealed.

• #6 Scurvy – Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://www.medindia.net/health/conditions/scurvy.htm

  Scurvy is diagnosed by a physical examination and taking medical history along with detailed questions about dietary habits into account, in which an inadequate or low intake of fresh fruit and vegetables is identified. […] Blood tests – to check vitamin C and iron levels. Scurvy is confirmed by a blood test for ascorbic acid showing levels and response of symptoms to treatment with vitamin C supplements and fresh fruit and vegetables. […] X rays – Generalized osteopenia [low bone density], cortical thinning or pencil-point cortex, intra articular hemorrhage, scorbutic rosary due to expansion of the costochondral junctions, Wimbergers ring sign [circular, opaque radiologic shadow surrounding epiphyseal centres of ossification, which may result from bleeding] are common findings in children. Other findings include well calcified cartilage seen as white line of Fraenkel. Subperiosteal bleeding into joint may become calcified making the joint assume a club or dumbbell shape. […] In adults, osteopenia and pathologic fractures are commonly seen.

• #7 Scurvy – Don’t Forget the Bubbles

  https://dontforgetthebubbles.com/scurvy/

  Scurvy is rare in higher income countries and therefore often forgotten as a potential differential diagnosis. […] Scurvy is a clinical diagnosis based on typical signs and symptoms alongside a dietary history of restrictive vitamin C intake for at least 1-3 months. Unfortunately, most laboratories cannot process ascorbic acid levels. However, if they can be measured, a level less than 11 umol/L would be considered deficient. […] The diagnosis is, in the main, a clinical one. When signs and symptoms respond to dietary changes or supplementation with Vitamin C, you know you are on the right track. […] Scurvy is a preventable, easily treatable disease that, due to its non-specific symptoms, is often misdiagnosed or carries a delay in diagnosis, with patients presenting to healthcare professionals on multiple occasions. An excellent nutritional history is critical to diagnosis.

• #8 Scurvy: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24318-scurvy

  Your healthcare provider can diagnose scurvy based on your symptoms. Theyll perform a physical examination and evaluate you based on certain risk factors for the condition. […] Your healthcare provider may request a blood test to measure the amount of vitamin C in your blood. In addition, they may perform a test called a dermoscopy. With this procedure, theyll take a sample of your affected skin or hair (biopsy) and examine it under a microscope. […] Scurvy treatment is essential to avoid further complications. The condition is easily treatable by consuming more vitamin C. You should try to maintain a nutritious diet that includes one to two times your daily recommended amount of vitamin C. You can do so by adding fresh fruits and vegetables to every meal. […] Most people feel better within 48 hours of treatment. You should be able to make a full recovery within two weeks. Some symptoms may take longer to fully clear up. Depending on the cause of your condition, your provider may refer you to a specialist for further treatment.

• #9 Scurvy: Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.verywellhealth.com/what-is-scurvy-401331

  Scurvy can be diagnosed with a combination of diagnostic strategies, including medical history, physical examination, and a blood test. Because the symptoms are vague, other, more common diagnoses may be considered before scurvy is considered. For example, your medical team may consider illnesses such as infections, hemophilia, a blood cancer like leukemia, idiopathic thrombocytopenic purpura, or vasculitis. […] Once you are diagnosed with scurvy, your medical team may also search for a cause. Your diet can be the reason for a vitamin C deficiency, but if you are eating enough vitamin C rich foods, a gastrointestinal problem could be causing your condition. […] Vitamin C blood levels are not commonly performed unless there is a specific request. However, if there is a concern that your vitamin C level could be the cause of your symptoms, a blood level of vitamin C (also called ascorbic acid) can be checked to confirm the diagnosis of scurvy.

• #10 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  Scurvy is a multi-organ syndrome caused by a deficiency of vitamin C. Although historically significant, scurvy is being increasingly diagnosed in the modern era due to the growing prevalence of risk factors including socioeconomic barriers to quality nutrition, smoking, alcohol consumption, chronic illness, and dialysis. […] A diagnosis of scurvy was confirmed with undetectable serum vitamin C (0.1 mg/dL; reference range, 0.42.0 mg/dL), and a subsequent dietary history revealed recent food insecurity. […] Nutritional deficiencies, including vitamin C deficiency, are important to consider in patients with complex medical and social histories. High-risk groups deserving particular consideration are those demonstrating socio-economic barriers to healthcare and nutrition, patients with severe chronic illness, and patients on dialysis.

• #11 Scurvy

  https://iphone.visualdx.com/visualdx/diagnosis/?diagnosisId=52314&moduleId=103

  Scurvy is an acquired condition caused by a deficiency of vitamin C (L-ascorbic acid). Humans are unable to synthesize vitamin C; hence, it must be consumed in the diet. Deficiency of this essential nutrient causes impaired collagen synthesis, which leads to poor wound healing, capillary fragility, and bone abnormalities (eg, osteoporosis, fractures, bone marrow edema, demineralization, intraosseous hemorrhage). […] In developed countries, scurvy is a relatively rare diagnosis primarily found in older adults, those who abuse alcohol, and infants and children. Scurvy can present with wide clinical variation, including dermatologic, dental, bone, and systemic manifestations. Clinical features of scurvy may be observed within 8 weeks of inadequate intake of vitamin C. The initial symptoms include irritability, decreased appetite, and low-grade fever. Dermatologic signs include xerosis, hyperkeratosis, perifollicular hemorrhage, scattered petechiae and ecchymoses, and corkscrew hairs. Oral findings include swollen, friable gingiva. In children, scurvy can present with joint swelling and refusal to walk, and bone growth may be inhibited. Rare presentations of scurvy include proptosis due to orbital hemorrhage, skeletal muscle degeneration, cardiac hypertrophy, psychological changes, edema, and alopecia. Untreated, scurvy can be fatal; deaths have been reported due to infection, cerebral hemorrhage, or hemopericardium. In pediatric populations, at-risk individuals include those with iron overload, neurologic disorders, a history of bone marrow transplant, and/or chemotherapy. Additionally, children with restricted diets, especially in the setting of autism or developmental delay, are at increased risk.

• #12 Vitamin C Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493187/

  Vitamin C deficiency, commonly called scurvy, is a well-documented nutritional disorder with historical significance that continues to impact global health today. […] Classic signs of vitamin C deficiency include corkscrew hairs, perifollicular hemorrhages, and gingival bleeding. Scurvy is a rare and reversible condition that requires early diagnosis and treatment. […] This article defines the sources, metabolism, and functions of vitamin C, covering the diagnosis, physical manifestations, evaluation, treatment, prognosis, and prevention of vitamin C deficiency. […] Scurvy is diagnosed clinically through relevant medical history, physical examination observations, and a rapid response to vitamin C supplementation. […] A low plasma vitamin C level of less than 0.2 mg/dL may indicate scurvy, but chronic deficiency could be concealed.

• #13 What Is Scurvy? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/scurvy/

  Scurvy is a disease thats caused by a deficiency in vitamin C (aka ascorbic acid), which is rare in the developed world. […] Fortunately, scurvy is less of an issue now that we know eating foods with vitamin C can prevent it, says Michelle Zive, RD, a nutrition coach based in La Mesa, California. […] The symptoms of scurvy arent pleasant, but the disease is treatable and easy to recover from. […] Zive says scurvy usually presents as fatigue and inflamed gums. But symptoms can get worse as the condition progresses. […] A blood test may be needed to measure vitamin C levels and confirm the diagnosis anything lower than 11 micromoles per liter (mol/L) is considered a deficiency. […] Your doctor may also test the levels of vitamin C in your leukocytes, which are white blood cells that may show a clearer picture of vitamin C stores because these cells arent affected by recently ingested forms of vitamin C.

• #14 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://community.the-hospitalist.org/internalmedicine/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today-0

  The doctors noted that the patient had undergone sleeve gastrectomy, prompting them to inquire about his diet. They discovered that, because of financial difficulties, his diet primarily consisted of processed foods with little to no fruits or vegetables, and he had stopped taking supplements recommended by his gastroenterologist. Further tests revealed a vitamin D deficiency and a severe deficiency in vitamin C. With the diagnosis of scurvy confirmed, the doctors treated the patient with 1000 mg of ascorbic acid daily, along with cholecalciferol, folic acid, and a multivitamin complex, leading to a complete resolution of his symptoms. […] Scurvy can present with a range of symptoms, including petechiae, perifollicular hemorrhage, ecchymosis, gingivitis, edema, anemia, delayed wound healing, malaise, weakness, joint swelling, arthralgia, anorexia, neuropathy, and vasomotor instability. It can cause mucosal and gastric hemorrhages, and if left untreated, it can lead to fatal bleeding.

• #15 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #16 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #17 Vitamin C Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency

  Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. […] Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal. […] Skeletal radiographs can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. […] Laboratory diagnosis, which requires measuring blood ascorbic acid, is sometimes done at academic centers. Levels of 0.6 mg/dL (34 mcmol/L) are considered marginal; levels of 0.2 mg/dL (11 mcmol/L) indicate vitamin C deficiency. […] In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic.

• #18 Scurvy: Symptoms, Risk Factors, Treatment, Recovery, and More

  https://www.healthline.com/health/scurvy

  If you suspect you have scurvy, a doctor will ask questions about your dietary history, check for signs of the condition, and order a blood test. […] The blood test will be used to check the levels of vitamin C in your blood serum. Generally, people with scurvy have blood serum levels of vitamin C that are less than 11 micromoles per liter (mol/L).

• #19 Vitamin C Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493187/

  A vitamin C level of 0 mg/dL in leukocytes indicates scurvy. A range of 0 to 7 mg/dL indicates a deficiency, whereas levels exceeding 15 mg/dL are considered sufficient. […] The appropriate dosage of vitamin C for scurvy treatment varies based on the severity of the condition and the individual’s particular requirements. Prompt vitamin C supplementation can quickly and efficiently replenish depleted vitamin levels in patients, with dosages up to 300 mg/d for children and 500 to 1000 mg/d for adults. […] Treating scurvy involves consuming sufficient fruits and vegetables to prevent recurrences and addressing the underlying causes of malnutrition that lead to vitamin C deficiency.

• #20 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #21 What Is Scurvy? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/scurvy/

  Scurvy is a disease thats caused by a deficiency in vitamin C (aka ascorbic acid), which is rare in the developed world. […] Fortunately, scurvy is less of an issue now that we know eating foods with vitamin C can prevent it, says Michelle Zive, RD, a nutrition coach based in La Mesa, California. […] The symptoms of scurvy arent pleasant, but the disease is treatable and easy to recover from. […] Zive says scurvy usually presents as fatigue and inflamed gums. But symptoms can get worse as the condition progresses. […] A blood test may be needed to measure vitamin C levels and confirm the diagnosis anything lower than 11 micromoles per liter (mol/L) is considered a deficiency. […] Your doctor may also test the levels of vitamin C in your leukocytes, which are white blood cells that may show a clearer picture of vitamin C stores because these cells arent affected by recently ingested forms of vitamin C.

• #22 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #23 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #24 Scurvy: Symptoms, causes, treatment, and prevention

  https://www.medicalnewstoday.com/articles/155758

  Usually, a doctor will diagnose a person with scurvy based on the symptoms and confirm the diagnosis if the person improves after taking vitamin C supplements. […] Taking a blood test to see a persons level of vitamin C is unreliable because it shows only the current levels as opposed to broader deficits. However, a doctor can order a lab test to check for conditions that can occur as a result such as anemia. […] In children, an x-ray can reveal internal damage resulting from childhood scurvy.

• #25 Scurvy (vitamin C deficiency)

  https://dermnetnz.org/topics/scurvy

  Scurvy should be considered on the clinical presentation and confirmed with recovery after Vitamin C supplementation. […] Serum levels of Vitamin C reflect recent intake rather than body stores, so are unreliable. Investigation of other nutritional deficiencies should be undertaken. […] In children, characteristic changes are seen on X-ray: Frankel sign, a dense line in the metaphysis due to increased calcification of the cartilage matrix; Trummerfeld zone due to subperiosteal haemorrhage; Wimberger ring sign in the epiphysis; Pelkan sign due to microfractures.

• #26 Vitamin C Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency

  Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. […] Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal. […] Skeletal radiographs can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. […] Laboratory diagnosis, which requires measuring blood ascorbic acid, is sometimes done at academic centers. Levels of 0.6 mg/dL (34 mcmol/L) are considered marginal; levels of 0.2 mg/dL (11 mcmol/L) indicate vitamin C deficiency. […] In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic.

• #27 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #28 Scurvy – Wikipedia

  https://en.wikipedia.org/wiki/Scurvy

  Diagnosis is typically based on physical signs, X-rays, and improvement after treatment. […] Diagnosis is typically based on outward appearance, X-rays, and improvement after treatment.

• #29 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #30 Hypovitaminosis C (scurvy) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hypovitaminosis-c-scurvy-1?lang=us

  Scurvy is a condition caused by a dietary lack of vitamin C (ascorbic acid), hence is also called hypovitaminosis C, and is characterized by an increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing. […] Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. bleeding gums, petechiae), and impaired wound healing. […] Lack of dietary vitamin C (ascorbic acid) may be related to inadequate food intake, the destruction of vitamin C in food caused by cooking and canning, or the absence of fresh fruit in the diet. […] Vitamin C is essential for collagen synthesis, acting as a coenzyme to producing cross-linking of collagen fibers. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. […] Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage.

• #31 Scurvy (Vitamin C Deficiency) Differential Diagnoses

  https://emedicine.medscape.com/article/125350-differential

  The differential diagnosis of scurvy includes vasculitis, thrombocytopenia, multiple myeloma, and folliculitis. […] Suspect vitamin C deficiency when perifollicular hemorrhages with corkscrew hairs are present. […] A good dietary history and the response to treatment with vitamin C establish the diagnosis and clear confusion. […] When evaluating a patient with suspected scurvy, other conditions such as the following should also be considered: Acrodynia, Autoimmune diseases (eg, Henoch-Schnlein purpura, systemic lupus erythematosus, Sjogren syndrome), Child abuse and neglect, Clotting factor deficiencies, Disseminated intravascular coagulation, Hematologic malignancies (eg, acute lymphoblastic leukemia), Hypersensitivity vasculitis (leukocytoclastic vasculitis), Medication side effects, Necrotizing gingivitis, Platelet dysfunction (eg, immune thrombocytopenic purpura), Senile purpura, Thrombophlebitis, Vitamin D deficiency and related disorders. […] The bony pathology associated with scurvy could potentially be confused with physical abuse of a child.

• #32 Scurvy: Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.verywellhealth.com/what-is-scurvy-401331

  Scurvy can be diagnosed with a combination of diagnostic strategies, including medical history, physical examination, and a blood test. Because the symptoms are vague, other, more common diagnoses may be considered before scurvy is considered. For example, your medical team may consider illnesses such as infections, hemophilia, a blood cancer like leukemia, idiopathic thrombocytopenic purpura, or vasculitis. […] Once you are diagnosed with scurvy, your medical team may also search for a cause. Your diet can be the reason for a vitamin C deficiency, but if you are eating enough vitamin C rich foods, a gastrointestinal problem could be causing your condition. […] Vitamin C blood levels are not commonly performed unless there is a specific request. However, if there is a concern that your vitamin C level could be the cause of your symptoms, a blood level of vitamin C (also called ascorbic acid) can be checked to confirm the diagnosis of scurvy.

• #33 Scurvy (Vitamin C Deficiency) Differential Diagnoses

  https://emedicine.medscape.com/article/125350-differential

  The differential diagnosis of scurvy includes vasculitis, thrombocytopenia, multiple myeloma, and folliculitis. […] Suspect vitamin C deficiency when perifollicular hemorrhages with corkscrew hairs are present. […] A good dietary history and the response to treatment with vitamin C establish the diagnosis and clear confusion. […] When evaluating a patient with suspected scurvy, other conditions such as the following should also be considered: Acrodynia, Autoimmune diseases (eg, Henoch-Schnlein purpura, systemic lupus erythematosus, Sjogren syndrome), Child abuse and neglect, Clotting factor deficiencies, Disseminated intravascular coagulation, Hematologic malignancies (eg, acute lymphoblastic leukemia), Hypersensitivity vasculitis (leukocytoclastic vasculitis), Medication side effects, Necrotizing gingivitis, Platelet dysfunction (eg, immune thrombocytopenic purpura), Senile purpura, Thrombophlebitis, Vitamin D deficiency and related disorders. […] The bony pathology associated with scurvy could potentially be confused with physical abuse of a child.

• #34 Scurvy: Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.verywellhealth.com/what-is-scurvy-401331

  Scurvy can be diagnosed with a combination of diagnostic strategies, including medical history, physical examination, and a blood test. Because the symptoms are vague, other, more common diagnoses may be considered before scurvy is considered. For example, your medical team may consider illnesses such as infections, hemophilia, a blood cancer like leukemia, idiopathic thrombocytopenic purpura, or vasculitis. […] Once you are diagnosed with scurvy, your medical team may also search for a cause. Your diet can be the reason for a vitamin C deficiency, but if you are eating enough vitamin C rich foods, a gastrointestinal problem could be causing your condition. […] Vitamin C blood levels are not commonly performed unless there is a specific request. However, if there is a concern that your vitamin C level could be the cause of your symptoms, a blood level of vitamin C (also called ascorbic acid) can be checked to confirm the diagnosis of scurvy.

• #35 Scurvy: Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.verywellhealth.com/what-is-scurvy-401331

  A diet that is lacking in fresh fruits and vegetables (oranges, lemons, potatoes, broccoli, tomatoes, spinach, and red peppers, to name a few) can increase your chances of developing scurvy. […] Your medical team may evaluate issues such as diarrhea, irritable bowel syndrome (IBS), or inflammatory bowel disease (IBD). Tests that help identify these conditions include a stool sample, imaging studies, and/or a colonoscopy.

• #36 Scurvy: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24318-scurvy

  Your healthcare provider can diagnose scurvy based on your symptoms. Theyll perform a physical examination and evaluate you based on certain risk factors for the condition. […] Your healthcare provider may request a blood test to measure the amount of vitamin C in your blood. In addition, they may perform a test called a dermoscopy. With this procedure, theyll take a sample of your affected skin or hair (biopsy) and examine it under a microscope. […] Scurvy treatment is essential to avoid further complications. The condition is easily treatable by consuming more vitamin C. You should try to maintain a nutritious diet that includes one to two times your daily recommended amount of vitamin C. You can do so by adding fresh fruits and vegetables to every meal. […] Most people feel better within 48 hours of treatment. You should be able to make a full recovery within two weeks. Some symptoms may take longer to fully clear up. Depending on the cause of your condition, your provider may refer you to a specialist for further treatment.

• #37 Scurvy. A forgotten pseudovasculitis | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-scurvy-a-forgotten-pseudovasculitis-articulo-S2173574324000662

  Differential diagnosis is made with purpura-related conditions (vasculitis, infections, idiopathic thrombocytopenic purpura, Ehlers-Danlos) or bleeding (coagulation disorders). Given that it is a pseudovasculitis, a biopsy is useful to rule out vascular inflammation. […] The present case is a reminder of the importance of including this pseudovasculitis in the differential diagnosis of any patient with purpuric lesions or hemarthrosis.

• #38 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://www.mdedge.com/hematology-oncology/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today

  Additionally, a skin biopsy showed no causative findings. […] Further tests revealed a vitamin D deficiency and a severe deficiency in vitamin C. With the diagnosis of scurvy confirmed, the doctors treated the patient with 1000 mg of ascorbic acid daily, along with cholecalciferol, folic acid, and a multivitamin complex, leading to a complete resolution of his symptoms. […] Scurvy can present with a range of symptoms, including petechiae, perifollicular hemorrhage, ecchymosis, gingivitis, edema, anemia, delayed wound healing, malaise, weakness, joint swelling, arthralgia, anorexia, neuropathy, and vasomotor instability. […] Today’s risk factors for scurvy include malnutrition, gastrointestinal disorders (eg, chronic inflammatory bowel diseases), alcohol and tobacco use, eating disorders, psychiatric illnesses, dialysis, and the use of medications that reduce the absorption of ascorbic acid (such as corticosteroids and proton pump inhibitors). […] Awareness of this can facilitate the timely diagnosis of scurvy in these patients.

• #39 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #40 Scurvy: Symptoms, causes, treatment, and prevention

  https://www.medicalnewstoday.com/articles/155758

  Usually, a doctor will diagnose a person with scurvy based on the symptoms and confirm the diagnosis if the person improves after taking vitamin C supplements. […] Taking a blood test to see a persons level of vitamin C is unreliable because it shows only the current levels as opposed to broader deficits. However, a doctor can order a lab test to check for conditions that can occur as a result such as anemia. […] In children, an x-ray can reveal internal damage resulting from childhood scurvy.

• #41 Scurvy may occur even in children with no underlying risk factors: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-2341-z

  Scurvy is caused by vitamin C deficiency. Cutaneous bleeding, mucosal bleeding, and anemia represent typical manifestations of the disease. These symptoms are directly connected to ascorbic acid involvement in collagen biosynthesis. Some radiographic findings can be useful for the diagnosis. Treatment aims to normalize serum levels of vitamin C in order to counteract the deprivation symptoms. The present case report demonstrates that scurvy may sporadically occur in pediatric patients, even in individuals with no predisposing medical conditions and/or potential risk factors. […] A diagnosis of scurvy was assessed on the basis of nutritional history, clinical features, radiographic findings, and laboratory findings. […] The diagnostic suspicion of scurvy is based on a combination of clinical signs and radiographic findings. The dosage of serum vitamin C levels is considered specific but laboratory tests are insensitive. […] The prompt resolution of symptoms after substitutive treatment represents the main evidence to confirm the diagnosis of scurvy.

• #42 Scurvy: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24318-scurvy

  Your healthcare provider can diagnose scurvy based on your symptoms. Theyll perform a physical examination and evaluate you based on certain risk factors for the condition. […] Your healthcare provider may request a blood test to measure the amount of vitamin C in your blood. In addition, they may perform a test called a dermoscopy. With this procedure, theyll take a sample of your affected skin or hair (biopsy) and examine it under a microscope. […] Scurvy treatment is essential to avoid further complications. The condition is easily treatable by consuming more vitamin C. You should try to maintain a nutritious diet that includes one to two times your daily recommended amount of vitamin C. You can do so by adding fresh fruits and vegetables to every meal. […] Most people feel better within 48 hours of treatment. You should be able to make a full recovery within two weeks. Some symptoms may take longer to fully clear up. Depending on the cause of your condition, your provider may refer you to a specialist for further treatment.

• #43 What Is Scurvy? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/scurvy/

  Though the symptoms are unpleasant, scurvy is easily treated, and those who are treated recover quickly. […] Scurvy doesnt last long after vitamin C levels begin to bounce back. […] In mild cases, scurvy can be treated simply with vitamin Crich foods, Springer says. […] More severe cases, however, may require supplemental vitamin C, Springer says, and supplementation may also help you heal faster. […] The only medication to treat scurvy is vitamin Crich foods and vitamin C supplementation (pill form, intravenous, or injected). […] To prevent scurvy, make sure youre getting enough vitamin C.

• #44 Vitamin C deficiency – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/632

  Vitamin C deficiency can lead to scurvy, a potentially life-threatening condition. […] Diagnosis is often delayed because of slow identification of disease or incomplete review of dietary history. […] Key diagnostic factors include vitamin C deficiency upon dietary review, constitutional symptoms, easy bruising or bleeding, gait impairment or leg pain, pedal oedema, petechial and perifollicular haemorrhages (legs and feet), poor wound healing, bruising and nodular or black ecchymoses at non-traumatic sites, joint swelling, oral mucosal petechiae, coiled hairs, follicular hyperkeratosis, tooth loss, gingival discoloration, gum swelling, lid petechiae and haemorrhages, proptosis, conjunctival and subconjunctival haemorrhage. […] Diagnosis is often delayed because of slow identification of disease or incomplete review of dietary history.

• #45 Vitamin C deficiency – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/632

  Vitamin C deficiency can lead to scurvy, a potentially life-threatening condition. […] Diagnosis is often delayed due to slow identification of disease or incomplete review of dietary history. […] Key diagnostic factors include vitamin C deficiency upon dietary review, constitutional symptoms, easy bruising or bleeding, gait impairment or leg pain, pedal edema, petechial and perifollicular hemorrhages (legs and feet), poor wound healing, bruising and nodular or black ecchymoses at nontraumatic sites, joint swelling, oral mucosal petechiae, coiled hairs, follicular hyperkeratosis, tooth loss, gingival discoloration, gum swelling, lid petechiae and hemorrhages, proptosis, conjunctival and subconjunctival hemorrhage. […] Diagnosis is often delayed due to slow identification of disease or incomplete review of dietary history. Rapid resolution occurs after vitamin C treatment.

• #46

  https://journals.lww.com/onlinejets/fulltext/2024/17020/scurvy__a_rare_disease_or_a_rare_diagnosis_.2.aspx

  Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness sake. […] The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies. […] Scurvy is primarily a clinical diagnosis, supported by laboratory tests (serum ascorbic acid level, normal range, 0.6-2.0 mg/dL or 0.2-1.5 mg/dL depending upon the reference laboratory performing the test). […] I propose that if scurvy was entertained as a diagnosis at appropriate times, case reports would gradually be replaced by case series and a more accurate understanding of the prevalence of scurvy in modern societies would emerge.

• #47 Scurvy: A Rare Disease or a Rare Diagnosis?

  https://jdc.jefferson.edu/emfp/245/

  Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness sake. […] The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies.

• #48 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #49

  https://www.orthobullets.com/basic-science/9034/scurvy

  Scurvy is disease caused by severe Vitamin C deficiency which presents with joint effusions, swelling over long bones, bleeding gums, loosening of teeth, hematuria, and susceptibility to hemorrhage. […] Diagnosis is made based on history, clinical and radiological picture, and resolution of symptoms following vitamin C administration. Lab tests are usually not helpful. […] The diagnosis is usually made based on history, clinical and radiological picture, and resolution of symptoms following vitamin C administration. Lab tests are usually not helpful.

• #50 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #51 Vitamin C Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency

  Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. […] Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal. […] Skeletal radiographs can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. […] Laboratory diagnosis, which requires measuring blood ascorbic acid, is sometimes done at academic centers. Levels of 0.6 mg/dL (34 mcmol/L) are considered marginal; levels of 0.2 mg/dL (11 mcmol/L) indicate vitamin C deficiency. […] In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic.

• #52 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  The diagnosis of scurvy is made clinically with a careful symptom and dietary history as well as physical exam. It is supported by low serum vitamin C, although recent vitamin C intake can normalize serum levels even if tissue levels are deficient. […] This case highlights the contributions of dialysis and food insecurity to vitamin C deficiency, additionally reflecting the specific dermatologic manifestations of scurvy and the importance of continuing vitamin C supplementation after initial treatment. […] Healthcare providers should maintain a high index of suspicion for nutrient deficiencies and consider a detailed dietary history, clinical nutritionist engagement, and selective laboratory testing when treating high-risk populations presenting with unexplained bleeding, new neuropsychiatric symptoms, or skin and body hair changes. Adequate supplementation with vitamin C should be initiated promptly in suspected cases of scurvy, and nutrition education should be provided to prevent recurrence.

• #53 Scurvy (vitamin C deficiency)

  https://dermnetnz.org/topics/scurvy

  Scurvy should be considered on the clinical presentation and confirmed with recovery after Vitamin C supplementation. […] Serum levels of Vitamin C reflect recent intake rather than body stores, so are unreliable. Investigation of other nutritional deficiencies should be undertaken. […] In children, characteristic changes are seen on X-ray: Frankel sign, a dense line in the metaphysis due to increased calcification of the cartilage matrix; Trummerfeld zone due to subperiosteal haemorrhage; Wimberger ring sign in the epiphysis; Pelkan sign due to microfractures.

• #54 Vitamin C Deficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493187/

  A vitamin C level of 0 mg/dL in leukocytes indicates scurvy. A range of 0 to 7 mg/dL indicates a deficiency, whereas levels exceeding 15 mg/dL are considered sufficient. […] The appropriate dosage of vitamin C for scurvy treatment varies based on the severity of the condition and the individual’s particular requirements. Prompt vitamin C supplementation can quickly and efficiently replenish depleted vitamin levels in patients, with dosages up to 300 mg/d for children and 500 to 1000 mg/d for adults. […] Treating scurvy involves consuming sufficient fruits and vegetables to prevent recurrences and addressing the underlying causes of malnutrition that lead to vitamin C deficiency.

• #55 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #56 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #57 Vitamin C Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency

  Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. […] Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal. […] Skeletal radiographs can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. […] Laboratory diagnosis, which requires measuring blood ascorbic acid, is sometimes done at academic centers. Levels of 0.6 mg/dL (34 mcmol/L) are considered marginal; levels of 0.2 mg/dL (11 mcmol/L) indicate vitamin C deficiency. […] In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic.

• #58 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://blogs.the-hospitalist.org/internalmedicine/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today-0

  Petechial rash often prompts further investigation into hematological, dermatological, or vasculitis causes. However, if the above investigations are negative and skin biopsy has not revealed a cause, there is a Renaissance-era diagnosis that is often overlooked but is easily investigated and treated, wrote Andrew Dermawan, MD, and colleagues from Sir Charles Gairdner Hospital in Nedlands, Australia, in BMJ Case Reports. The diagnosis they highlight is scurvy, a disease that has faded from common medical concern but is reemerging, partly because of the rise in bariatric surgery. […] In their article, Dermawan and colleagues present the case of a 50-year-old man with a bilateral petechial rash on his lower limbs, without any history of trauma. The patient, who exhibited no infectious symptoms, also had gross hematuria, microcytic anemia, mild neutropenia, and lymphopenia. Tests for autoimmune and hematological diseases were negative, as were abdominal and leg CT scans, ruling out abdominal hemorrhage and vasculitis. Additionally, a skin biopsy showed no causative findings.

• #59 Vitamin C Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency

  Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. […] Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal. […] Skeletal radiographs can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. […] Laboratory diagnosis, which requires measuring blood ascorbic acid, is sometimes done at academic centers. Levels of 0.6 mg/dL (34 mcmol/L) are considered marginal; levels of 0.2 mg/dL (11 mcmol/L) indicate vitamin C deficiency. […] In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic.

• #60 MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs – Indian Journal of Musculoskeletal Radiology (IJMSR)

  https://mss-ijmsr.com/mri-as-an-aid-to-diagnosis-of-scurvy-in-absence-of-classic-clinical-and-radiographic-signs/

  Scurvy, a Vitamin C deficiency disorder leads to impaired synthesis of collagen, osteoid, and dentine, causing cutaneous, dental, and skeletal manifestations, respectively. […] The radiographic features of scurvy are very well established but the increasing use of magnetic resonance imaging (MRI) in limb pathologies warrants radiologists to be aware of its common as well as atypical magnetic resonance findings. […] MRI confirmed physeal separation of the distal femur with subperiosteal collection. […] Inflammatory markers were normal. […] These two cases highlight the significance of MRI in reaching a diagnosis in atypical cases of scurvy which has excellent response to Vitamin C supplementation. […] However, with the increasing use of advanced imaging modalities such as magnetic resonance imaging (MRI), it is inevitable to know the imaging features of this new old nutritional deficiency disorder.

• #61 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. […] A specific and reproducible reverse-phase, high-pressure liquid chromatographic method has been found to reliably measure vitamin C in lymphocytes. […] A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water. […] Radiographic findings in infantile scurvy are diagnostic and may show any of the following: Subperiosteal elevation, Fractures and dislocation, Alveolar bone reabsorption, Ground-glass appearance of cortex. […] The earliest radiologic manifestation of infantile scurvy is generally seen at the distal ends of the radii where fuzziness of the lateral aspects of the cortices is present with slight rarefaction of the neighboring cancellous bone. […] As the disease progresses, radiographs demonstrate characteristic changes at the cartilage-shaft junctions of the long bones, especially at the distal ends of the femurs. Key imaging features show osteoporosis.

• #62 Vitamin C Deficiency – Nutritional Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c-deficiency

  Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. […] Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal. […] Skeletal radiographs can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. […] Laboratory diagnosis, which requires measuring blood ascorbic acid, is sometimes done at academic centers. Levels of 0.6 mg/dL (34 mcmol/L) are considered marginal; levels of 0.2 mg/dL (11 mcmol/L) indicate vitamin C deficiency. […] In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic.

• #63 Scurvy (vitamin C deficiency)

  https://dermnetnz.org/topics/scurvy

  Scurvy should be considered on the clinical presentation and confirmed with recovery after Vitamin C supplementation. […] Serum levels of Vitamin C reflect recent intake rather than body stores, so are unreliable. Investigation of other nutritional deficiencies should be undertaken. […] In children, characteristic changes are seen on X-ray: Frankel sign, a dense line in the metaphysis due to increased calcification of the cartilage matrix; Trummerfeld zone due to subperiosteal haemorrhage; Wimberger ring sign in the epiphysis; Pelkan sign due to microfractures.

• #64 2nd Place Emage Winner: Scurvy | Pediatric Emergency Medicine

  https://www.acep.org/pediatrics/emage-winners2/2021-emages-winners/2nd-place-emage-winner-scurvy

  Radiographs of the distal femur and proximal tibia showed dense zones of provisional calcification (F: Frankel lines) with bony spurring noted at the bilateral distal femur and proximal tibia (P: Pelkan spurs) with underlying lucent metaphyseal bands (T: Trmmerfeld zone). […] These radiographic findings, in conjunction with the clinical findings of mucosal bleeding, perifollicular petechiae, and arthralgias, suggested a diagnosis of scurvy. […] The diagnosis of scurvy can be made by history and physical exam findings confirmed by radiographs showing Frankel lines or Trmmerfeld zones, or a low serum ascorbic acid level. […] As a result of their clinical presentation, imaging findings, and rapid clinical improvement with nutritional supplementation, the patients final diagnosis was that of scurvy.

• #65 Scurvy – Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://www.medindia.net/health/conditions/scurvy.htm

  Scurvy is diagnosed by a physical examination and taking medical history along with detailed questions about dietary habits into account, in which an inadequate or low intake of fresh fruit and vegetables is identified. […] Blood tests – to check vitamin C and iron levels. Scurvy is confirmed by a blood test for ascorbic acid showing levels and response of symptoms to treatment with vitamin C supplements and fresh fruit and vegetables. […] X rays – Generalized osteopenia [low bone density], cortical thinning or pencil-point cortex, intra articular hemorrhage, scorbutic rosary due to expansion of the costochondral junctions, Wimbergers ring sign [circular, opaque radiologic shadow surrounding epiphyseal centres of ossification, which may result from bleeding] are common findings in children. Other findings include well calcified cartilage seen as white line of Fraenkel. Subperiosteal bleeding into joint may become calcified making the joint assume a club or dumbbell shape. […] In adults, osteopenia and pathologic fractures are commonly seen.

• #66 MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs – Indian Journal of Musculoskeletal Radiology (IJMSR)

  https://mss-ijmsr.com/mri-as-an-aid-to-diagnosis-of-scurvy-in-absence-of-classic-clinical-and-radiographic-signs/

  Scurvy, a Vitamin C deficiency disorder leads to impaired synthesis of collagen, osteoid, and dentine, causing cutaneous, dental, and skeletal manifestations, respectively. […] The radiographic features of scurvy are very well established but the increasing use of magnetic resonance imaging (MRI) in limb pathologies warrants radiologists to be aware of its common as well as atypical magnetic resonance findings. […] MRI confirmed physeal separation of the distal femur with subperiosteal collection. […] Inflammatory markers were normal. […] These two cases highlight the significance of MRI in reaching a diagnosis in atypical cases of scurvy which has excellent response to Vitamin C supplementation. […] However, with the increasing use of advanced imaging modalities such as magnetic resonance imaging (MRI), it is inevitable to know the imaging features of this new old nutritional deficiency disorder.

• #67 MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs – Indian Journal of Musculoskeletal Radiology (IJMSR)

  https://mss-ijmsr.com/mri-as-an-aid-to-diagnosis-of-scurvy-in-absence-of-classic-clinical-and-radiographic-signs/

  The presence of normal to near normal radiographs is not unlikely even in cases of severe Vitamin C deficiency. […] MRI findings of intraosseous and subperiosteal hemorrhages raised a possibility of scurvy in this case. […] MRI as a cross-section imaging tool is of value in atypical scurvy cases as the heterogenous signal of hematomas in the medullary cavity and beneath the periosteum helps it to differentiate it from the subperiosteal abscess of osteomyelitis. […] Thus, we conclude that MRI in atypical settings can hint at an underlying diagnosis. […] We do not recommend MRI in typical cases of scurvy as radiographs remain the choice of investigation for diagnosis and for evaluating the treatment response. […] However, normal radiographs can be seen in scurvy, and it is in such atypical cases that MRI helps in reaching a diagnosis.

• #68 MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs – Indian Journal of Musculoskeletal Radiology (IJMSR)

  https://mss-ijmsr.com/mri-as-an-aid-to-diagnosis-of-scurvy-in-absence-of-classic-clinical-and-radiographic-signs/

  Scurvy, a Vitamin C deficiency disorder leads to impaired synthesis of collagen, osteoid, and dentine, causing cutaneous, dental, and skeletal manifestations, respectively. […] The radiographic features of scurvy are very well established but the increasing use of magnetic resonance imaging (MRI) in limb pathologies warrants radiologists to be aware of its common as well as atypical magnetic resonance findings. […] MRI confirmed physeal separation of the distal femur with subperiosteal collection. […] Inflammatory markers were normal. […] These two cases highlight the significance of MRI in reaching a diagnosis in atypical cases of scurvy which has excellent response to Vitamin C supplementation. […] However, with the increasing use of advanced imaging modalities such as magnetic resonance imaging (MRI), it is inevitable to know the imaging features of this new old nutritional deficiency disorder.

• #69 MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs – Indian Journal of Musculoskeletal Radiology (IJMSR)

  https://mss-ijmsr.com/mri-as-an-aid-to-diagnosis-of-scurvy-in-absence-of-classic-clinical-and-radiographic-signs/

  The presence of normal to near normal radiographs is not unlikely even in cases of severe Vitamin C deficiency. […] MRI findings of intraosseous and subperiosteal hemorrhages raised a possibility of scurvy in this case. […] MRI as a cross-section imaging tool is of value in atypical scurvy cases as the heterogenous signal of hematomas in the medullary cavity and beneath the periosteum helps it to differentiate it from the subperiosteal abscess of osteomyelitis. […] Thus, we conclude that MRI in atypical settings can hint at an underlying diagnosis. […] We do not recommend MRI in typical cases of scurvy as radiographs remain the choice of investigation for diagnosis and for evaluating the treatment response. […] However, normal radiographs can be seen in scurvy, and it is in such atypical cases that MRI helps in reaching a diagnosis.

• #70 MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs – Indian Journal of Musculoskeletal Radiology (IJMSR)

  https://mss-ijmsr.com/mri-as-an-aid-to-diagnosis-of-scurvy-in-absence-of-classic-clinical-and-radiographic-signs/

  The presence of normal to near normal radiographs is not unlikely even in cases of severe Vitamin C deficiency. […] MRI findings of intraosseous and subperiosteal hemorrhages raised a possibility of scurvy in this case. […] MRI as a cross-section imaging tool is of value in atypical scurvy cases as the heterogenous signal of hematomas in the medullary cavity and beneath the periosteum helps it to differentiate it from the subperiosteal abscess of osteomyelitis. […] Thus, we conclude that MRI in atypical settings can hint at an underlying diagnosis. […] We do not recommend MRI in typical cases of scurvy as radiographs remain the choice of investigation for diagnosis and for evaluating the treatment response. […] However, normal radiographs can be seen in scurvy, and it is in such atypical cases that MRI helps in reaching a diagnosis.

• #71 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://www.mdedge.com/hematology-oncology/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today

  “Petechial rash often prompts further investigation into hematological, dermatological, or vasculitis causes. However, if the above investigations are negative and skin biopsy has not revealed a cause, there is a Renaissance-era diagnosis that is often overlooked but is easily investigated and treated,” wrote Andrew Dermawan, MD, and colleagues from Sir Charles Gairdner Hospital in Nedlands, Australia, in BMJ Case Reports. The diagnosis they highlight is scurvy, a disease that has faded from common medical concern but is reemerging, partly because of the rise in bariatric surgery. […] In their article, Dermawan and colleagues present the case of a 50-year-old man with a bilateral petechial rash on his lower limbs, without any history of trauma. […] Tests for autoimmune and hematological diseases were negative, as were abdominal and leg CT scans, ruling out abdominal hemorrhage and vasculitis.

• #72 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://blogs.the-hospitalist.org/internalmedicine/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today-0

  Petechial rash often prompts further investigation into hematological, dermatological, or vasculitis causes. However, if the above investigations are negative and skin biopsy has not revealed a cause, there is a Renaissance-era diagnosis that is often overlooked but is easily investigated and treated, wrote Andrew Dermawan, MD, and colleagues from Sir Charles Gairdner Hospital in Nedlands, Australia, in BMJ Case Reports. The diagnosis they highlight is scurvy, a disease that has faded from common medical concern but is reemerging, partly because of the rise in bariatric surgery. […] In their article, Dermawan and colleagues present the case of a 50-year-old man with a bilateral petechial rash on his lower limbs, without any history of trauma. The patient, who exhibited no infectious symptoms, also had gross hematuria, microcytic anemia, mild neutropenia, and lymphopenia. Tests for autoimmune and hematological diseases were negative, as were abdominal and leg CT scans, ruling out abdominal hemorrhage and vasculitis. Additionally, a skin biopsy showed no causative findings.

• #73 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  Scurvy is a multi-organ syndrome caused by a deficiency of vitamin C. Although historically significant, scurvy is being increasingly diagnosed in the modern era due to the growing prevalence of risk factors including socioeconomic barriers to quality nutrition, smoking, alcohol consumption, chronic illness, and dialysis. […] A diagnosis of scurvy was confirmed with undetectable serum vitamin C (0.1 mg/dL; reference range, 0.42.0 mg/dL), and a subsequent dietary history revealed recent food insecurity. […] Nutritional deficiencies, including vitamin C deficiency, are important to consider in patients with complex medical and social histories. High-risk groups deserving particular consideration are those demonstrating socio-economic barriers to healthcare and nutrition, patients with severe chronic illness, and patients on dialysis.

• #74 Scurvy

  https://iphone.visualdx.com/visualdx/diagnosis/?diagnosisId=52314&moduleId=103

  Scurvy is an acquired condition caused by a deficiency of vitamin C (L-ascorbic acid). Humans are unable to synthesize vitamin C; hence, it must be consumed in the diet. Deficiency of this essential nutrient causes impaired collagen synthesis, which leads to poor wound healing, capillary fragility, and bone abnormalities (eg, osteoporosis, fractures, bone marrow edema, demineralization, intraosseous hemorrhage). […] In developed countries, scurvy is a relatively rare diagnosis primarily found in older adults, those who abuse alcohol, and infants and children. Scurvy can present with wide clinical variation, including dermatologic, dental, bone, and systemic manifestations. Clinical features of scurvy may be observed within 8 weeks of inadequate intake of vitamin C. The initial symptoms include irritability, decreased appetite, and low-grade fever. Dermatologic signs include xerosis, hyperkeratosis, perifollicular hemorrhage, scattered petechiae and ecchymoses, and corkscrew hairs. Oral findings include swollen, friable gingiva. In children, scurvy can present with joint swelling and refusal to walk, and bone growth may be inhibited. Rare presentations of scurvy include proptosis due to orbital hemorrhage, skeletal muscle degeneration, cardiac hypertrophy, psychological changes, edema, and alopecia. Untreated, scurvy can be fatal; deaths have been reported due to infection, cerebral hemorrhage, or hemopericardium. In pediatric populations, at-risk individuals include those with iron overload, neurologic disorders, a history of bone marrow transplant, and/or chemotherapy. Additionally, children with restricted diets, especially in the setting of autism or developmental delay, are at increased risk.

• #75 Scurvy: Forgotten diagnosis, but still exist

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7082595/

  Scurvy is a rare condition in pediatric patients, resulted from a vitamin C deficiency. Musculoskeletal symptoms occur in 80% of patient. The rarity and the polymorphisms of the clinical signs and symptoms often make scurvy an unknown or forgotten diagnosis. […] Because of the extremely rare occurrence of scurvy in modern society at present, it is difficult to differentiate it from other diseases such as infection. The diagnosis of scurvy is made by careful studies from history taking, physical examination, laboratory and especially radiological finding that show pathognomonic appearance. Examination of vitamin C level serum is a gold standard, but unfortunately not available in our country. Improvement after vitamin C administration also established that condition. […] Scurvy should have established by clinical and radiological findings that show pathognomonic signs around joint, even without supported by vitamin C serum.

• #76 Scurvy: A Case Report on a Child With Autism | Lim | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/321/0

  Scurvy is a nutritional deficiency which has currently become uncommon. Accurate history taking, strong suspicion and good clinical correlation especially in high risk groups are important in making an early diagnosis. […] In practice, the diagnosis of scurvy is based on history and clinical findings. In cases of suspicion, resolution of disease manifestations after vitamin C supplementation remains the best diagnostic evidence. High index of suspicion is crucial to diagnose scurvy early in modern era. Early diagnosis is important for prompt initiation of treatment and fast resolution of symptoms.

• #77 Scurvy

  https://iphone.visualdx.com/visualdx/diagnosis/?diagnosisId=52314&moduleId=103

  Scurvy is an acquired condition caused by a deficiency of vitamin C (L-ascorbic acid). Humans are unable to synthesize vitamin C; hence, it must be consumed in the diet. Deficiency of this essential nutrient causes impaired collagen synthesis, which leads to poor wound healing, capillary fragility, and bone abnormalities (eg, osteoporosis, fractures, bone marrow edema, demineralization, intraosseous hemorrhage). […] In developed countries, scurvy is a relatively rare diagnosis primarily found in older adults, those who abuse alcohol, and infants and children. Scurvy can present with wide clinical variation, including dermatologic, dental, bone, and systemic manifestations. Clinical features of scurvy may be observed within 8 weeks of inadequate intake of vitamin C. The initial symptoms include irritability, decreased appetite, and low-grade fever. Dermatologic signs include xerosis, hyperkeratosis, perifollicular hemorrhage, scattered petechiae and ecchymoses, and corkscrew hairs. Oral findings include swollen, friable gingiva. In children, scurvy can present with joint swelling and refusal to walk, and bone growth may be inhibited. Rare presentations of scurvy include proptosis due to orbital hemorrhage, skeletal muscle degeneration, cardiac hypertrophy, psychological changes, edema, and alopecia. Untreated, scurvy can be fatal; deaths have been reported due to infection, cerebral hemorrhage, or hemopericardium. In pediatric populations, at-risk individuals include those with iron overload, neurologic disorders, a history of bone marrow transplant, and/or chemotherapy. Additionally, children with restricted diets, especially in the setting of autism or developmental delay, are at increased risk.

• #78 Scurvy may occur even in children with no underlying risk factors: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-2341-z

  Scurvy is caused by vitamin C deficiency. Cutaneous bleeding, mucosal bleeding, and anemia represent typical manifestations of the disease. These symptoms are directly connected to ascorbic acid involvement in collagen biosynthesis. Some radiographic findings can be useful for the diagnosis. Treatment aims to normalize serum levels of vitamin C in order to counteract the deprivation symptoms. The present case report demonstrates that scurvy may sporadically occur in pediatric patients, even in individuals with no predisposing medical conditions and/or potential risk factors. […] A diagnosis of scurvy was assessed on the basis of nutritional history, clinical features, radiographic findings, and laboratory findings. […] The diagnostic suspicion of scurvy is based on a combination of clinical signs and radiographic findings. The dosage of serum vitamin C levels is considered specific but laboratory tests are insensitive. […] The prompt resolution of symptoms after substitutive treatment represents the main evidence to confirm the diagnosis of scurvy.

• #79 Internet Scientific Publications

  https://ispub.com/IJPN/10/2/5342

  A 28 months old boy presented in the casualty for evaluation of lower limb weakness and difficulty in walking since last 2 weeks and being referred as acute flaccid palsy suspected as Guillen Barre Syndrome for further management. […] The clinical presentation and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy. […] Diagnosis of vitamin C deficiency is usually based on the characteristic clinical picture, the radiographic appearance of the long bones, and a history of poor vitamin C Intake. […] Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL aids in precluding vitamin C deficiency, but an even lower concentrations dose not necessarily indicate deficiency.

• #80 Internet Scientific Publications

  https://ispub.com/IJPN/10/2/5342

  A 28 months old boy presented in the casualty for evaluation of lower limb weakness and difficulty in walking since last 2 weeks and being referred as acute flaccid palsy suspected as Guillen Barre Syndrome for further management. […] The clinical presentation and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy. […] Diagnosis of vitamin C deficiency is usually based on the characteristic clinical picture, the radiographic appearance of the long bones, and a history of poor vitamin C Intake. […] Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL aids in precluding vitamin C deficiency, but an even lower concentrations dose not necessarily indicate deficiency.

• #81 Internet Scientific Publications

  https://ispub.com/IJPN/10/2/5342

  This case highlights that scurvy should be kept as differential in any child presenting with lower limb weakness with marked tenderness which may mimic acute flaccid paralysis. […] It can be easily confirmed with X ray of long bones with characteristic features as described and it is easily treatable with oral vitamin C. […] Scurvy should be kept as a differential diagnosis in a young child presenting with bleeding manifestations or only with difficulty in walking without other features.

• #82 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://www.mdedge.com/hematology-oncology/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today

  “Petechial rash often prompts further investigation into hematological, dermatological, or vasculitis causes. However, if the above investigations are negative and skin biopsy has not revealed a cause, there is a Renaissance-era diagnosis that is often overlooked but is easily investigated and treated,” wrote Andrew Dermawan, MD, and colleagues from Sir Charles Gairdner Hospital in Nedlands, Australia, in BMJ Case Reports. The diagnosis they highlight is scurvy, a disease that has faded from common medical concern but is reemerging, partly because of the rise in bariatric surgery. […] In their article, Dermawan and colleagues present the case of a 50-year-old man with a bilateral petechial rash on his lower limbs, without any history of trauma. […] Tests for autoimmune and hematological diseases were negative, as were abdominal and leg CT scans, ruling out abdominal hemorrhage and vasculitis.

• #83 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://blogs.the-hospitalist.org/internalmedicine/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today-0

  Petechial rash often prompts further investigation into hematological, dermatological, or vasculitis causes. However, if the above investigations are negative and skin biopsy has not revealed a cause, there is a Renaissance-era diagnosis that is often overlooked but is easily investigated and treated, wrote Andrew Dermawan, MD, and colleagues from Sir Charles Gairdner Hospital in Nedlands, Australia, in BMJ Case Reports. The diagnosis they highlight is scurvy, a disease that has faded from common medical concern but is reemerging, partly because of the rise in bariatric surgery. […] In their article, Dermawan and colleagues present the case of a 50-year-old man with a bilateral petechial rash on his lower limbs, without any history of trauma. The patient, who exhibited no infectious symptoms, also had gross hematuria, microcytic anemia, mild neutropenia, and lymphopenia. Tests for autoimmune and hematological diseases were negative, as were abdominal and leg CT scans, ruling out abdominal hemorrhage and vasculitis. Additionally, a skin biopsy showed no causative findings.

• #84 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://www.mdedge.com/hematology-oncology/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today

  Additionally, a skin biopsy showed no causative findings. […] Further tests revealed a vitamin D deficiency and a severe deficiency in vitamin C. With the diagnosis of scurvy confirmed, the doctors treated the patient with 1000 mg of ascorbic acid daily, along with cholecalciferol, folic acid, and a multivitamin complex, leading to a complete resolution of his symptoms. […] Scurvy can present with a range of symptoms, including petechiae, perifollicular hemorrhage, ecchymosis, gingivitis, edema, anemia, delayed wound healing, malaise, weakness, joint swelling, arthralgia, anorexia, neuropathy, and vasomotor instability. […] Today’s risk factors for scurvy include malnutrition, gastrointestinal disorders (eg, chronic inflammatory bowel diseases), alcohol and tobacco use, eating disorders, psychiatric illnesses, dialysis, and the use of medications that reduce the absorption of ascorbic acid (such as corticosteroids and proton pump inhibitors). […] Awareness of this can facilitate the timely diagnosis of scurvy in these patients.

• #85 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://blogs.the-hospitalist.org/internalmedicine/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today-0

  The doctors noted that the patient had undergone sleeve gastrectomy, prompting them to inquire about his diet. They discovered that, because of financial difficulties, his diet primarily consisted of processed foods with little to no fruits or vegetables, and he had stopped taking supplements recommended by his gastroenterologist. Further tests revealed a vitamin D deficiency and a severe deficiency in vitamin C. With the diagnosis of scurvy confirmed, the doctors treated the patient with 1000 mg of ascorbic acid daily, along with cholecalciferol, folic acid, and a multivitamin complex, leading to a complete resolution of his symptoms. […] Scurvy can present with a range of symptoms, including petechiae, perifollicular hemorrhage, ecchymosis, gingivitis, edema, anemia, delayed wound healing, malaise, weakness, joint swelling, arthralgia, anorexia, neuropathy, and vasomotor instability. It can cause mucosal and gastric hemorrhages, and if left untreated, it can lead to fatal bleeding.

• #86 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  Scurvy is a multi-organ syndrome caused by a deficiency of vitamin C. Although historically significant, scurvy is being increasingly diagnosed in the modern era due to the growing prevalence of risk factors including socioeconomic barriers to quality nutrition, smoking, alcohol consumption, chronic illness, and dialysis. […] A diagnosis of scurvy was confirmed with undetectable serum vitamin C (0.1 mg/dL; reference range, 0.42.0 mg/dL), and a subsequent dietary history revealed recent food insecurity. […] Nutritional deficiencies, including vitamin C deficiency, are important to consider in patients with complex medical and social histories. High-risk groups deserving particular consideration are those demonstrating socio-economic barriers to healthcare and nutrition, patients with severe chronic illness, and patients on dialysis.

• #87 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  The diagnosis of scurvy is made clinically with a careful symptom and dietary history as well as physical exam. It is supported by low serum vitamin C, although recent vitamin C intake can normalize serum levels even if tissue levels are deficient. […] This case highlights the contributions of dialysis and food insecurity to vitamin C deficiency, additionally reflecting the specific dermatologic manifestations of scurvy and the importance of continuing vitamin C supplementation after initial treatment. […] Healthcare providers should maintain a high index of suspicion for nutrient deficiencies and consider a detailed dietary history, clinical nutritionist engagement, and selective laboratory testing when treating high-risk populations presenting with unexplained bleeding, new neuropsychiatric symptoms, or skin and body hair changes. Adequate supplementation with vitamin C should be initiated promptly in suspected cases of scurvy, and nutrition education should be provided to prevent recurrence.

• #88 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  The diagnosis of scurvy is made clinically with a careful symptom and dietary history as well as physical exam. It is supported by low serum vitamin C, although recent vitamin C intake can normalize serum levels even if tissue levels are deficient. […] This case highlights the contributions of dialysis and food insecurity to vitamin C deficiency, additionally reflecting the specific dermatologic manifestations of scurvy and the importance of continuing vitamin C supplementation after initial treatment. […] Healthcare providers should maintain a high index of suspicion for nutrient deficiencies and consider a detailed dietary history, clinical nutritionist engagement, and selective laboratory testing when treating high-risk populations presenting with unexplained bleeding, new neuropsychiatric symptoms, or skin and body hair changes. Adequate supplementation with vitamin C should be initiated promptly in suspected cases of scurvy, and nutrition education should be provided to prevent recurrence.

• #89 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  Vitamin C deficiency, or scurvy, can manifest with specific dermatologic signs and less specific systemic symptoms, including changes in cognition and bleeding. This case highlights the importance of considering vitamin C deficiency in patients with complex social and medical histories whose presentation may be explained, in part, by vitamin C deficiency.

• #90 Scurvy: A Diagnosis Still Relevant Today | MDedge

  https://blogs.the-hospitalist.org/internalmedicine/article/271517/gastroenterology/scurvy-diagnosis-still-relevant-today-0

  Todays risk factors for scurvy include malnutrition, gastrointestinal disorders (eg, chronic inflammatory bowel diseases), alcohol and tobacco use, eating disorders, psychiatric illnesses, dialysis, and the use of medications that reduce the absorption of ascorbic acid (such as corticosteroids and proton pump inhibitors). Scurvy remains more common among individuals with unfavorable socioeconomic conditions. […] Awareness of this can facilitate the timely diagnosis of scurvy in these patients.

• #91 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  Scurvy is a multi-organ syndrome caused by a deficiency of vitamin C. Although historically significant, scurvy is being increasingly diagnosed in the modern era due to the growing prevalence of risk factors including socioeconomic barriers to quality nutrition, smoking, alcohol consumption, chronic illness, and dialysis. […] A diagnosis of scurvy was confirmed with undetectable serum vitamin C (0.1 mg/dL; reference range, 0.42.0 mg/dL), and a subsequent dietary history revealed recent food insecurity. […] Nutritional deficiencies, including vitamin C deficiency, are important to consider in patients with complex medical and social histories. High-risk groups deserving particular consideration are those demonstrating socio-economic barriers to healthcare and nutrition, patients with severe chronic illness, and patients on dialysis.

• #92 Persistent scurvy after vitamin C supplementation in a high-risk patient: a case report – Oles – AME Medical Journal

  https://amj.amegroups.org/article/view/9986/html

  The diagnosis of scurvy is made clinically with a careful symptom and dietary history as well as physical exam. It is supported by low serum vitamin C, although recent vitamin C intake can normalize serum levels even if tissue levels are deficient. […] This case highlights the contributions of dialysis and food insecurity to vitamin C deficiency, additionally reflecting the specific dermatologic manifestations of scurvy and the importance of continuing vitamin C supplementation after initial treatment. […] Healthcare providers should maintain a high index of suspicion for nutrient deficiencies and consider a detailed dietary history, clinical nutritionist engagement, and selective laboratory testing when treating high-risk populations presenting with unexplained bleeding, new neuropsychiatric symptoms, or skin and body hair changes. Adequate supplementation with vitamin C should be initiated promptly in suspected cases of scurvy, and nutrition education should be provided to prevent recurrence.

• #93

  https://consensus.app/questions/what-is-scurvy-disease/

  Scurvy can mimic several other conditions, making its diagnosis challenging. […] Therefore, a thorough dietary history and physical examination are crucial for accurate diagnosis. […] The gold standard for diagnosing scurvy is the measurement of serum vitamin C levels. […] Early recognition and diagnosis are essential to avoid unnecessary investigations and prevent potentially fatal complications. […] Scurvy, caused by a nutritional deficiency of Vitamin C, is a potential diagnosis in at-risk patients with symptoms like lethargy, gum disease, and easy bruising. […] Scurvy is a rare but potentially fatal disease, and early recognition and vitamin C supplementation are crucial for preventing severe complications. […] Scurvy is a potential risk in children with autism spectrum disorder and severe food selectivity, and diagnosis requires a nutrition evaluation and laboratory testing before more elaborate testing.

• #94 Scurvy (Vitamin C Deficiency) Workup: Approach Considerations, Plasma, Leukocyte, and Urinary Vitamin C Levels, Radiography

  https://emedicine.medscape.com/article/125350-workup

  Laboratory tests are usually not helpful to ascertain a diagnosis of scurvy. Presentation of an infant with the typical clinical and radiologic picture of scurvy, along with a supportive history of dietary deficiency of vitamin C, is often sufficient to diagnose infantile scurvy. […] Plasma ascorbic acid level may help in establishing the diagnosis, but this level tends to reflect the recent dietary intake rather than the actual tissue levels of vitamin C. Signs of scurvy can occur with low-normal serum levels of vitamin C. […] The best confirmation of the diagnosis of scurvy is its resolution following vitamin C administration. […] Obtaining a plasma or leukocyte vitamin C level can confirm the clinical diagnosis. […] A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Serum ascorbic acid levels of less than 0.2 mg/dL are deficient. levels of 0.2-0.29 mg/dL are low, and levels greater than 0.3 mg/dL are acceptable. Scurvy generally occurs at levels less than 0.1 mg/dL.

• #95

  https://www.orthobullets.com/basic-science/9034/scurvy

  Scurvy is disease caused by severe Vitamin C deficiency which presents with joint effusions, swelling over long bones, bleeding gums, loosening of teeth, hematuria, and susceptibility to hemorrhage. […] Diagnosis is made based on history, clinical and radiological picture, and resolution of symptoms following vitamin C administration. Lab tests are usually not helpful. […] The diagnosis is usually made based on history, clinical and radiological picture, and resolution of symptoms following vitamin C administration. Lab tests are usually not helpful.

• #96 Scurvy – Don’t Forget the Bubbles

  https://dontforgetthebubbles.com/scurvy/

  Scurvy is rare in higher income countries and therefore often forgotten as a potential differential diagnosis. […] Scurvy is a clinical diagnosis based on typical signs and symptoms alongside a dietary history of restrictive vitamin C intake for at least 1-3 months. Unfortunately, most laboratories cannot process ascorbic acid levels. However, if they can be measured, a level less than 11 umol/L would be considered deficient. […] The diagnosis is, in the main, a clinical one. When signs and symptoms respond to dietary changes or supplementation with Vitamin C, you know you are on the right track. […] Scurvy is a preventable, easily treatable disease that, due to its non-specific symptoms, is often misdiagnosed or carries a delay in diagnosis, with patients presenting to healthcare professionals on multiple occasions. An excellent nutritional history is critical to diagnosis.

• #97 Scurvy: When it is a Forgotten Illness the Surgery Makes the Diagnosis

  https://www.openorthopaedicsjournal.com/VOLUME/11/PAGE/1314/FULLTEXT/

  Unlike most of animal species, human beings lack the enzymatic process for the conversion of glucose to ascorbic acid (vitaminC), and therefore getting the vitamin from food sources is essential. […] We describe here the case of a 4-year-old girl with cerebral palsy, in whom diagnosis concerns were oriented for osteomyelitis, based upon clinical presentation, ultrasonic and magnetic resonance imaging, led to a surgery revealing subperiosteal hematomas that argues in favor of scurvy. […] Recent studies of sporadic cases report a high incidence of scurvy in children with autism or psychomotor retardation and the fact that musculoskeletal manifestations are more common. The rarity and the polymorphisms of the clinical signs make scurvy an often unknown diagnosis. […] The diagnosis of scurvy is based on clinical and radiological findings and low serum vitamin C levels, while a good response of the patient to vitamin C treatment makes the diagnosis definitive. […] A heightened awareness is needed to avoid an unnecessary surgery, unnecessary tests and procedures and to be able to start treatment for a potentially fatal but easily curable disease.

• #98 Scurvy: Causes, Diagnosis, Treatment, and Symptoms

  https://www.medicoverhospitals.in/diseases/scurvy/

  Scurvy diagnosis involves medical history, physical exam, and blood test, with treatment focusing on vitamin C-rich foods and supplements. […] Your doctor will ask you for your medical history and perform a physical examination to diagnose the symptoms. […] The doctor assesses dietary habits and symptom improvement post-enrichment with vitamin C supplements, fresh fruits, and vegetables to diagnose scurvy. […] Blood tests confirm scurvy with ascorbic acid levels 11 mol/L, while radiologic findings assess bone damage and growth issues in children.

• #99 Scurvy. A forgotten pseudovasculitis | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-scurvy-a-forgotten-pseudovasculitis-articulo-S2173574324000662

  Scurvy is a nutritional disease caused by ascorbic acid (vitamin C) deficiency. Although currently it is a rare disease, we should consider it in the differential diagnosis of purpura and arthritis in patients with restrictive diets. […] Finally, the diagnosis of scurvy was made upon demonstration poor levels of vitamin C and a spectacular response to nutritional supplements. […] In view of the high suspicion of scurvy, intravenous vitamin C was administered, and suppressed levels of vitamins C, A, K1, and zinc were confirmed in the following days. […] In our case, the history of an eating disorder, hemarthrosis, and desmoscopic findings enabled us to guide the diagnosis. Vitamin C levels are not routinely tested for in laboratory analyses and waiting for the result would delay diagnosis/treatment.

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