Scurvy: Difference between revisions

Latest revision as of 18:13, 11 December 2024

Background

Normal dermal anatomy.

Nutritional deficiency of Vitamin C (Ascorbic acid)
Vitamin C is typically found in fruits and vegetables.
Vitamin C is a cofactor for hydroxylation of proline and lysine amino acids in procollagen molecules, which is required for cross-linking collagen's triple helix.
Scurvy therefore leads to unstable collagen and collagen fragility.
- Leaking of vascular structures
  - Gingival bleeding
  - Petechiae
  - Easy bruising
Vitamin C is also required for the disulfide bonding in hair leading to corkscrew appearance of hair.
16th-19th century sailors with scurvy found to have developed tooth decay, bruising, lassitude, and often died from massive hemorrhage^[1]

Risk Factors

Eating disorders or select eating habits
Infants who only consume pasteurized milk
Autism
Alcohol disorder
Isolated elderly persons with poor nutrition

Clinical Features

Corkscrew hair in a patient with scurvy.

Petechiae in a patient with scurvy.

Bruising in a patient with scurvy.

Gingival bleeding in a patient with scurvy.

Gingival bleeding
Easy bruising
Petechiae
Corkscrew hair
Perifollicular hemmorrhage
Weakness, fatigue, and muscle cramping
- Vitamin C is cofactor for enzymes involved in biosynthesis of carnitine, which is essential for release of energy via transport of fatty acids into mitochondria^[2]
Mood disturbance, cognitive impairment, delusions and depression^[3]
- Vitamin C is a modulator of neurotransmitter synthesis and release (e.g. Dopamine)^[4]
Anemia
- Vit C promotes intestinal absorption of Iron and prevents oxidative damage to the red-cell cytoskeleton^[5]

Differential Diagnosis

Petechiae/Purpura (by cause)

Abnormal platelet count and/or coagulation
- Septicemia
- Idiopathic thrombocytopenic purpura (ITP)
- Hemolytic uremic syndrome
- Leukemia
- Coagulopathies (e.g. hemophilia)
- Henoch-Schonlein Purpura (HSP)
- Acute hemorrhagic edema of infancy (AHEI)
Hypersensitivity vasculitis
Primary vasculitides
- Wegener's
- Microscopic polyangiitis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Secondary vasculitides
- Henoch-Schonlein purpura
- Connective tissue disorder
  - Systemic lupus erythematosus
- Scurvy
- Infectious disease
  - Hepatitis B
  - Hepatitis C
Trauma

Dentoalveolar Injuries

Odontogenic Infections

Acute alveolar osteitis (dry socket)
Acute necrotizing ulcerative gingivitis (trench mouth)
Dental abscess
- Periapical abscess
- Periodontal abscess
Ludwig's angina
Pulpitis (dental caries)
Pericoronitis
Peritonsillar abscess (PTA)
Retropharyngeal abscess
Vincent's angina - tonsillitis and pharyngitis

Other

Vitamin deficiencies

Vitamin A deficiency
Vitamin B deficiencies
- Vitamin B1 deficiency (Thiamine)
  - Beriberi
  - Wernicke-Korsakoff syndrome
- Vitamin B3 deficiency (Pellagra)
- Vitamin B9 deficiency (Folate)
- Vitamin B7 deficiency (Biotin)
- Vitamin B12 deficiency
Vitamin C deficiency (Scurvy)
Vitamin D deficiency (Rickets)
Vitamin E deficiency
Vitamin K deficiency
Zinc deficiency
- Acrodermatitis enteropathica

Evaluation

Guided by clinical suspicion but confirmed with laboratory analysis of vitamin C levels.

Management

Vitamin C supplementation.
- 1 gram of oral vitamin C daily

Disposition

Depends on the manifestations of vitamin C and their severity

External Links

References

Kluesner, Nicholas and Miller, daniel. “Scurvy: Malnourishment in the land of the plenty.” The journal of emergency medicine. Vol 46. no 4. pages 530-532. 2014.
Maltos, andre, et al. “Scurvy in a patient with AIDS: case report.” Revista de sociedade brasileira de medicina tropical 44(1): 122-123. 2011.

↑ Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.
↑ Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.
↑ Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.
↑ Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.
↑ Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.

Authors:

[1] Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.

[2] Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.

[3] Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.

[4] Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.

[5] Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 ==Background==
-Scurvy is the nutritional deficiency of Vitamin C (Ascorbic acid).  Vitamin C is typically foundin fruits and vegetables. Vitamin C is a cofactor for hydroxylation of proline and lysine amino acids in procollagen molecules, which is required for cross-linking collagen's triple helix.  Scurvy therefore leads to unstable collagen and collagen fragility.  This leads to the following:
+{{Skin anatomy background images}}
-**leaking of vascular structures
+*Nutritional deficiency of Vitamin C (Ascorbic acid)
-***gingival bleeding
+*Vitamin C is typically found in fruits and vegetables.
-***petechiae
+*Vitamin C is a cofactor for hydroxylation of proline and lysine amino acids in procollagen molecules, which is required for cross-linking collagen's triple helix.
-***easy bruising
+*Scurvy therefore leads to unstable collagen and collagen fragility.
+**Leaking of vascular structures
+***Gingival bleeding
+***[[Petechiae]]
+***Easy bruising
+*Vitamin C is also required for the disulfide bonding in hair leading to corkscrew appearance of hair.
+*16th-19th century sailors with scurvy found to have developed tooth decay, bruising, lassitude, and often died from massive hemorrhage<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
+===Risk Factors===
+*Eating disorders or select eating habits
+*Infants who only consume pasteurized milk
+*Autism
+*Alcohol disorder
+*Isolated elderly persons with poor nutrition
-Vitamin C is also required for the disulfide bonding in hair.  Deficiency will thus lead to the following:
-**Corkscrew appearance of hair.
 ==Clinical Features==
-*Gingival bleeding
+[[File:Corkscrew hair.png|thumb|Corkscrew hair in a patient with scurvy.]]
+[[File:Petechiae.png|thumb|Petechiae in a patient with scurvy.]]
+[[File: Scruvy_-_Easy_bruising.png |thumb|Bruising in a patient with scurvy.]]
+[[File: Gingival_bleeding.png |thumb|Gingival bleeding in a patient with scurvy.]]
+*[[Gingival bleeding]]
 *Easy bruising
-*Petechiae
+*[[Petechiae]]
 *Corkscrew hair
+*Perifollicular hemmorrhage
+*Weakness, fatigue, and muscle cramping
+**Vitamin C is cofactor for enzymes involved in biosynthesis of carnitine, which is essential for release of energy via transport of fatty acids into mitochondria<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
+*Mood disturbance, cognitive impairment, delusions and depression<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
+**Vitamin C is a modulator of neurotransmitter synthesis and release (e.g. Dopamine)<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
+*Anemia
+**Vit C promotes intestinal absorption of Iron and prevents oxidative damage to the red-cell cytoskeleton<ref>Pichan, Cayla, B. S., et al. “Inadequate Support.” New England Journal of Medicine, vol. 385, no. 10, 2021, pp. 938–44.</ref>
 ==Differential Diagnosis==
+{{Purpura DDX}}
+{{Dental Problems DDX}}
+{{Vitamin deficiencies DDX}}
-==Diagnosis==
+==Evaluation==
+*Guided by clinical suspicion but confirmed with laboratory analysis of vitamin C levels.
 ==Management==
+*Vitamin C supplementation.
+**1 gram of oral vitamin C daily
 ==Disposition==
+*Depends on the manifestations of vitamin C and their severity
-==See Also==
 ==External Links==
 ==References==
-# Kluesner, Nicholas and Miller, daniel.  “Scurvy: Malnourishment in the land of the plenty.” The journal of emergency medicine. Vol 46. no 4.  pages 530-532. 2014.
+#Kluesner, Nicholas and Miller, daniel.  “Scurvy: Malnourishment in the land of the plenty.” The journal of emergency medicine. Vol 46. no 4.  pages 530-532. 2014.
-# Maltos, andre, et al.  “Scurvy in a patient with AIDS: case report.”  Revista de sociedade brasileira de medicina tropical 44(1): 122-123. 2011.
+#Maltos, andre, et al.  “Scurvy in a patient with AIDS: case report.”  Revista de sociedade brasileira de medicina tropical 44(1): 122-123. 2011.
 <references/>
+[[Category:Dermatology]]
+[[Category:FEN]]