Scurvy, an enduring mimicker and diagnostic dilemma in adults: A review of the 280 relevant published cases in the twenty-first century

Abstract

Background: Scurvy persists as a significant adult medical condition, frequently overlooked due to its mimicry of more common diseases. This review aims to analyse reported adult cases from the twenty-first century to characterize its current epidemiology, clinical presentation, and diagnostic challenges.

Methods: A systematic literature review was conducted across PubMed and MEDLINE for the period 2000-2025, including case reports, case series, and observational studies on adult scurvy. Non-informative texts and paediatric cases were excluded. Artificial intelligence (AI) tools were utilized to assist in translating non-English articles and to extract preliminary data from plain text. To ensure data integrity, all AI-generated variables were rigorously manually verified against the original full-text articles to correct any potential errors or hallucinations.

Results: We identified 280 cases of adult scurvy reported from 2000 to 2025. Predominant clinical features included skin lesions, specifically purpura and corkscrew hairs, alongside anaemia and haemorrhage. Social determinants of health played a critical role; many patients presented with restrictive diets, homelessness, or social isolation-risk factors often overlooked at initial presentation. The clinical picture was frequently obscured by nonspecific symptoms, such as general physical deterioration, rheumatological symptoms or oral manifestations leading to diagnostic delays and extensive, unnecessary investigations for autoimmune or haemostatic disorders.

Conclusion: Despite the varied presentations, early recognition remains crucial for effective management of this misdiagnosed condition mimicking more frequent diseases like autoimmune or haemostatic disorders to prompt rapid and efficacious vitamin C supplementation. Addressing social determinants of health, including poverty, social isolation, and limited access to nutritious food, is essential for preventing and managing scurvy within vulnerable populations.

Keywords: Adult; Ecchymosis; Purpura; Scurvy; Vitamin C deficiency.