Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_400_2023

Scurvy– Once a common condition likely to be missed in the uncommon times!

Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
Corresponding author: Dr. Rachita S Dhurat, Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India. rachitadhurat@yahoo.co.in
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Dhurat RS, Sharma R, Pai SU, Zatakia SM. Scurvy-Once a common condition likely to be missed in these uncommon times! Indian J Dermatol Venereol Leprol doi: 10.25259/IJDVL_400_2023

Dear Editor,

Scurvy, a Vitamin C deficiency disorder, has been documented since antiquity. An uncommon disease today, from a dermatological perspective, it can be missed due to subtle clinical signs. Thus one must correlate the characteristic clinico-radiologic findings and etiologic risk-factors for diagnosing scurvy.

A seven-year-old boy was admitted to the paediatric intensive care unit for seizures. The boy was diagnosed with West Syndrome at birth. Within seven days of admission, he developed fever, joint pain, abdominal pain, haematuria and ecchymotic patches. Treatment with systemic antibiotics, anticonvulsants, muscle relaxants and multivitamins were initiated by the paediatrician and he was referred to the dermatology department for ecchymotic patches. He was poorly built, lethargic with delayed milestones and spasticity in all four limbs. He had pallor and painful edema of the knee joints. Cutaneous examination revealed multiple ecchymotic patches over the knee joints and a few follicular and non-follicular palpable purpura on the lower limbs [Figure 1a]. We also noted sparse follicular keratotic papules and xerosis of the upper and lower limbs [Figure 1b]. We considered Henoch-Schönlein purpura and meningococcemia as differentials. Investigations revealed haemoglobin of 6.5 g/dL, reticulocyte count of 3.5%, white blood cell count of 8.3× 109/L with a normal differential count, and a platelet count of 233 × 109/L. His C-reactive protein level was 20 mg/L (normal <10 mg/L). Serum vitamin C level was 1.29 mg/dl (0.6–2 mg/dL). Blood cultures, coagulation profiles, electrolyte levels and liver and kidney function tests were all within reference ranges. Urine microscopy revealed 10 RBCs per field. Histopathological examination of palpable purpura revealed follicular plugging, a mild upper dermal lymphocytic infiltrate with extravasation of RBCs and no evidence of vasculitis. A radiological survey of the wrist and knees revealed cortical thinning, the Wimberger ring sign, the Frankel sign and the Pelkan spur [Figure 2]. The CT scan of brain showed subgaleal hematoma, cerebral atrophy and periventricular calcification. A normal blood culture and negative histopathologic features of Henoch-Schönlein purpura and the presence of characteristic radiological findings prompted the diagnosis of scurvy. The patient was re-evaluated for skin findings of scurvy. The dermoscopy of the keratotic papules revealed characteristic cork screw hair [Figure 3a]. Deep sectioning of histopathological tissue specimens revealed coiled hair [Figure 3b]. Thus the diagnosis of scurvy was confirmed. His ecchymotic patches and purpuric papules resolved completely with ten days of oral vitamin C (500 mg).

Figure 1a
Ecchymosis over knee joint
Figure 1b
Xerosis with keratotic plugs over the knee joint
Figure 2
Radiograph of knee joint
Figure 3a
Dermoscopy showing coiled hair
Figure 3b
Histopathology showing follicular plugging and corkscrew hair in epidermis (40x H&E stain)

Scurvy is a multiorgan systemic disease because of diversefunctions of vitamin C. The occurrence of scurvy in children with autism or other neuropsychiatric disorders is not uncommon. 1 Additionally, the high-risk groups include children with iron load due to multiple blood transfusions, anorexia nervosa, celiac disease, Crohn’s disease, haemodialysis and other causes of a restricted diet. 1 A few dermatological signs, which are seen in the early stages, are follicular hyperkeratosis and coiled corkscrew hair. 2 Broken and lustreless hair are due to abnormal disulfide bonding and keratin formation. 3 Fragile blood vessels resulting from impaired collagen synthesis give rise to perifollicular haemorrhages, petechiae and ecchymoses. 2 Rarely, we may see nail splinter haemorrhages and alopecia. 3 Serum vitamin C levels are considered specific, but laboratory tests are usually insensitive. It is known that serum concentrations do not always correspond with tissue storage of ascorbic acid. A reliable indicator of body storage is the measure of urinary excretion after intravenous ascorbic acid administration. Normally, 80% of absorbed vitamin C should be excreted within 3–5 hours. Also, the prompt resolution of symptoms after substitution treatment represents key evidence to confirm the diagnosis of scurvy. 4 Multivitamin therapy is initiated in most critical cases, which explains the normal serum vitamin C level in our case. The patient had very subtle cutaneous features, making the diagnosis challenging. The natural course of undetected and untreated vitamin C deficiency can result in seizures and cardiac abnormalities and cases of sudden death have also been reported. 5 This signifies the need for prompt detection and early treatment. The regimen for vitamin C supplementation in scurvy has not been established yet. Therapeutic supplementation with 1 g/day of oral vitamin C for 2 weeks is the usual treatment. 5 The dose and duration of treatment should be individualised.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

References

  1. . Scurvy: reemergence of nutritional deficiencies. Can Fam Physician. 2008;54:1403-6.
    [PubMed] [PubMed Central] [Google Scholar]
  2. , , , . Scurvy: a forgotten disease. Clin Exp Dermatol. 2005;30:735-6.
    [CrossRef] [PubMed] [Google Scholar]
  3. , . Scurvy in an otherwise well young man. Med J Aust. 2006;185:331-2.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , . Scurvy in 2017 through cases. Medico e Bambino. 2017;36:365-70.
    [Google Scholar]
  5. . Musculoskeletal manifestations of scurvy. Joint Bone Spine. 2005;72:124-8.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
1,876

PDF downloads
441
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections