United States: Scurvy, a disease caused by a deficiency in vitamin C, which was historically common among sailors and pirates, seems to be making a comeback due to rising living costs and the increasing frequency of weight loss surgeries, according to a new study.
“Scurvy is often viewed as a disease of the past, especially in developed nations,” Australian doctors noted in a report published Tuesday in BMJ Case Reports. “However, isolated cases still appear, particularly among the elderly, individuals with alcoholism, and children with psychiatric or developmental disorders.”
A group of medical professionals from Sir Charles Gairdner Hospital in Western Australia encountered a perplexing case involving an unemployed man in his 50s, a former smoker, who presented with an excruciating, spontaneous rash on both of his legs.
The patient’s symptoms escalated—hematuria, or blood in his urine, and anemia was noted, reflecting a marked deficiency in red blood cells.
Doctors, puzzled by the man’s case, initially found no evidence pointing to typical culprits like inflammatory diseases, autoimmune conditions, or blood-related disorders. Extensive scans showed no internal hemorrhaging and even a skin biopsy left the clinical team without answers.
However, during his hospital stay, the rash proliferated, bringing with it increased swelling, bruising, and worsening pain in his lower limbs.
After running a detailed nutritional evaluation, the mystery unraveled. His levels of vitamin C were so diminished they were virtually undetectable, along with other marked nutritional deficits.
It was soon revealed that his living conditions were far from optimal. The case report elaborated, “The patient faced considerable financial struggles, which led to severe dietary neglect. His intake largely consisted of processed food with little to no vegetables or fruit.” Furthermore, he frequently skipped meals in the preceding weeks and discontinued the use of prescribed vitamins and minerals following a gastric bypass surgery, as they were financially out of reach.
Eight years prior, the patient had undergone a sleeve gastrectomy—a surgical procedure that removed a significant portion of his stomach in an effort to aid weight loss.
Upon diagnosing him with scurvy, the medical team prescribed a regimen of 1,000 mg of vitamin C, 125 mcg of vitamin D3, 5 mg of folic acid, and a multivitamin, administered daily. In addition, a dietitian crafted a balanced meal plan, and the patient began consuming a lemon each day.
The outcome was swift and remarkable. The rash vanished, and no further blood appeared in his urine.
The study’s authors noted several risk factors contributing to scurvy, including inadequate nutrition, gastric bypass surgery, dialysis, alcoholism, a history of psychiatric disorders, and eating disorders.
“This disease is notably responsive to supplementation, with substantial improvement often seen within 24 hours,” the medical team wrote, adding, “Untreated, scurvy can lead to severe hemorrhage, making early diagnosis and immediate intervention critical.”
In the United States, recent data showed that the incidence of scurvy in children surged dramatically from 8.2 per 100,000 in 2016 to 26.7 per 100,000 by 2020. The affected individuals were predominantly younger, male, obese, and from economically disadvantaged backgrounds. Of particular note, nearly 65 percent of these children were diagnosed with autism.
The recommended daily intake of vitamin C stands at 90 mg for adult males and 75 mg for adult females. Pregnant and breastfeeding women, smokers, certain cancer patients, and those on specific medications may require higher amounts.
Research indicates that symptoms of scurvy can manifest as early as one month after vitamin C intake drops below 10 mg per day.
Dr Theodore Strange, Chair of Medicine at Northwell’s Staten Island University Hospital, reflected on the rarity of this condition, stating he hadn’t encountered a case of scurvy since his days in medical school.
“As the authors have highlighted, it remains an exceedingly rare condition in developed nations, particularly in the US, where the prevalence of vitamin C in food and supplements is typically sufficient to prevent its reoccurrence,” Dr Strange told The Post. “For those concerned, a simple multivitamin is a safe safeguard.”