Doctors have treated a Perth man for scurvy, prompting a warning the condition may be re-emerging due to current cost of living pressures.
Scurvy is caused by severe vitamin C deficiency and was first associated with sailors in the 18th century who had limited access to fresh fruit and vegetables. Signs can be present as early as one month after a person’s daily intake of vitamin C drops below 10mg.
Doctors who treated the man detailed his diagnosis in BMJ Case Reports, expressing concern the disease may be re-emerging due to the rising cost of living making it harder for people to afford nutritious food and a rise in weight loss surgery.
The man, in his early 50s, presented to Sir Charles Gairdner Hospital with tiny painful red-brown pinpoints on his legs, resembling a rash. Blood was also present in his urine and he was anaemic.
He tested negative for inflammatory, autoimmune, and blood disorders, and scans revealed no evidence of internal bleeding. Similarly, a skin biopsy returned no diagnostic clues. His rash continued to spread while he was in hospital.
Doctors later discovered he ate little in the way of fruit and vegetables and sometimes skipped meals because he was worried about money.
He had also stopped taking nutritional supplements prescribed for him after weight loss surgery because he said he could not afford them.
Blood tests found no detectable levels of vitamin C and very low levels of other nutrients, leading to his diagnosis of scurvy.
The man was treated with 1000mg of vitamin C daily, vitamin D3, folic acid and multivitamin supplements. His rash and other symptoms cleared up.
While it is not clear what the current prevalence of scurvy is, it is still considered relatively rare.
“Scurvy is still seen as a disease of the past, especially in developed countries,” doctors wrote in the case report.
“The rising cost of living also makes it harder for families to afford good quality nutritious foods, while there have been numerous reports of scurvy arising from complications following bariatric surgery.”
While scurvy is easily treated, because it is not common in the present day it may be mistaken for other conditions, especially inflamed blood vessels, risking fatal bleeding if left untreated.
Other risk factors for scurvy include alcoholism, smoking, eating disorders, obesity, kidney dialysis and drugs that interfere with vitamin C absorption such as steroids and those that curb stomach acid production (proton pump inhibitors).
“Our patient had multiple risk factors, namely poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors and low-income status,” the doctors said.
“His history of iron, vitamin D and folate deficiencies were also clues to his underlying nutritional deficiency.”