Rheumatic manifestations of scurvy: a report of three recent cases in a major urban center and a review

Abstract

Objectives: To report 3 cases of scurvy seen in a large urban medical center over a 6-month period, referred for evaluation of rheumatologic symptoms and findings in the presence of elevated inflammatory markers. The relevant literature is reviewed and unusual manifestations highlighted.

Methods: Descriptive case reports of 3 patients ultimately diagnosed with scurvy and a review of the relevant literature with an emphasis on rheumatologic manifestations (PubMed search, 1965 through August 2009).

Results: Three patients presented with symptoms including fatigue, purpuric rash, synovitis with effusion, anemia, and markedly elevated erythrocyte sedimentation rate and C-reactive protein levels. One patient presented with severe pulmonary hypertension. Careful nutritional history revealed a diet deficient in vitamin C. Examination revealed hemarthrosis, skin findings characteristic of scurvy, and deficiency in vitamin C on laboratory analysis. Symptoms resolved with vitamin C supplementation. Characteristics and frequency of rheumatologic manifestations are reviewed.

Conclusions: While scurvy is usually described in poorer countries, individuals who have psychiatric disorders, or alcoholics with poor nutrition, it can occur even in otherwise normal populations in affluent countries. Such patients often present to rheumatologists with rheumatologic symptoms and awareness of the disease is necessary to make the proper diagnosis.