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In a concerning trend, scurvy, a disease primarily caused by vitamin C deficiency, may be making a comeback due to the ongoing cost of living crisis and a significant rise in bariatric (weight loss) surgeries. This alarming suggestion comes from a case report published in BMJ Case Reports, where doctors treated a middle-aged man exhibiting classic symptoms of the disease.
Historically associated with sailors during the Renaissance era, scurvy is often overlooked in modern clinical settings, especially as it is seen as a disease of the past. However, the recent case underscores the potential risks of misdiagnosing the condition, which can mimic other illnesses, including vasculitis—an inflammation of blood vessels. Without appropriate treatment, misdiagnosis could lead to severe complications, including fatal bleeding.
The patient in question presented with painful red-brown pinpoints on his legs, resembling a rash, and reported blood in his urine, along with anemia. Initial tests ruled out inflammatory, autoimmune, and blood disorders, and imaging revealed no internal bleeding. Even a skin biopsy failed to provide diagnostic insights.
As his condition worsened during his hospital stay, further inquiry revealed troubling details about his lifestyle. Financial constraints led him to neglect his diet, significantly reducing his intake of fruits and vegetables, and he often skipped meals entirely. Compounding his health issues, he had ceased taking prescribed nutritional supplements after undergoing weight loss surgery due to financial difficulties.
Blood tests confirmed a concerning nutritional status, with undetectable levels of vitamin C and critically low levels of other essential nutrients. After a diagnosis of scurvy, he was promptly treated with a daily regimen of 1,000 mg of vitamin C, along with vitamin D3, folic acid, and multivitamin supplements. Remarkably, his symptoms improved, and his painful rash subsided.
While this single case raises awareness about scurvy, the current prevalence of the condition remains unclear. The authors of the study note that scurvy is still largely perceived as an affliction of the past, particularly in developed nations. They emphasize that the rising cost of living has made it increasingly challenging for families to access nutritious foods, potentially leading to a resurgence of vitamin deficiencies.
Furthermore, they identify several risk factors for scurvy, including alcoholism, smoking, eating disorders, low household income, obesity, and specific medical conditions, such as those undergoing kidney dialysis or taking medications that hinder vitamin C absorption.
“Our patient exhibited multiple risk factors, including poor dietary habits, obesity, previous bariatric surgery, and low-income status,” the authors concluded. “His history of iron, vitamin D, and folate deficiencies further pointed to underlying nutritional issues.”
As public health officials grapple with the impacts of economic strain on nutrition, this case serves as a stark reminder of the importance of monitoring vitamin levels, particularly in vulnerable populations.
For more information, refer to the original case report: Andrew Dermawan et al, Scurvy—a re-emerging disease with the rising cost of living and number of bariatric surgeries, BMJ Case Reports (2024). DOI: 10.1136/bcr-2024-261082.
