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Scurvy in Adult
See also in: Oral Mucosal Lesion
Other Resources UpToDate PubMed

Scurvy in Adult

See also in: Oral Mucosal Lesion
Contributors: Christine S. Ahn MD, FAAD, William W. Huang MD, MPH, FAAD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Scurvy is an acquired condition caused by a prolonged deficiency of vitamin C (L-ascorbic acid). Vitamin C is a water-soluble, essential vitamin that can only be obtained through the diet. It is an essential cofactor in the cross-linking and stabilization of collagen; thus, deficiency of this nutrient causes impaired collagen synthesis, leading to poor wound healing, capillary fragility, and bone abnormalities (eg, osteoporosis, fractures, bone marrow edema, demineralization, intraosseous hemorrhage). Symptoms can develop after 8-12 weeks of insufficient vitamin C intake.

Scurvy is a relatively rare diagnosis in the developed world. Pathognomonic clinical findings of scurvy include gingival bleeding and perifollicular petechiae with corkscrew hairs. Other common features include vascular fragility, manifesting as purpura, petechiae, ecchymoses, and gastrointestinal bleeding. Spontaneous hemorrhage into muscles, soft tissues, and joints can cause painful hematomas and hemarthroses. Symptoms include fatigue, weakness, muscle cramping, and malaise as well as cognitive impairment and mood disturbances.

Risk factors for developing scurvy include alcohol use, low socioeconomic status, restrictive diets or dietary fads, obesity, psychiatric disease, and malabsorption due to gastrointestinal disease. Additionally, older adults, especially those in social isolation; patients on dialysis; and individuals with increased metabolic requirements (such as pregnant or lactating individuals and patients with severe infections) are at increased risk. People who chronically abuse alcohol are particularly susceptible to scurvy not only due to poor dietary intake but also decreased ascorbic acid absorption.

Codes

ICD10CM:
E54 – Ascorbic acid deficiency

SNOMEDCT:
76169001 – Scurvy

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Cutaneous manifestations:
  • Leukocytoclastic vasculitis
  • Disseminated intravascular coagulation
  • Sjögren syndrome
  • Immune thrombocytopenic purpura
  • Systemic lupus erythematosus
  • Vitamin K deficiency
  • Rocky Mountain spotted fever
  • Acute meningococcemia
  • Solar purpura
  • Ehlers-Danlos syndrome
  • Cryoglobulinemia
  • Waldenström macroglobulinemia
  • Disorders of platelet function
  • Clotting factor deficiencies
  • Iatrogenic coagulopathy
  • Hematologic malignancy
  • Bateman purpura (Solar purpura) usually occurs on the forearms and would not have the associated follicular, bone, and gum changes.
Musculoskeletal manifestations:
  • Reactive arthritis 
  • Septic arthritis 
  • Osteomyelitis 
  • Malignancy (such as leukemia, metastases) 
Oral mucosal manifestations:
  • Chronic gingivitis / Periodontitis 
  • Necrotizing ulcerative gingivitis 
  • Leukemic gingivitis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:10/03/2017
Last Updated:08/30/2023
Copyright © 2024 VisualDx®. All rights reserved.
Scurvy in Adult
See also in: Oral Mucosal Lesion
A medical illustration showing key findings of Scurvy (Initial Stage) : Diarrhea, Fatigue, Fever, Malaise, Anorexia, Tachypnea, Poor weight gain
Clinical image of Scurvy - imageId=2760850. Click to open in gallery.  caption: 'A close-up of scattered perifollicular purpura and "corkscrew" hairs.'
A close-up of scattered perifollicular purpura and "corkscrew" hairs.
Copyright © 2024 VisualDx®. All rights reserved.