Scurvy is making a surprise comeback in Australia...
...an intensive care specialists say, after reporting a case in Brisbane.
(Scurvy is a condition that arises from the lack of Vitamin C).
In a report published this week in the Internal Medicine Journal, the specialists describe the case of a 56-year-old woman who presented with scurvy on a background of sepsis and arthritis.
She had recently undergone an uneventful total knee joint replacement, but returned to hospital 10 days later with septic shock.
She had multiple pretibial skin ulcers, extensive bruising and left lower lobe pneumonia complicated by a large empyema.
Her nurses reported that the patient’s gums bled when her teeth were brushed and, despite vigilant pressure care nursing, she developed several pressure ulcers and extensive bruises.
She also reported a diet poor in vegetables and citrus fruit.
But within seven days of vitamin C replacement, the woman’s condition significantly improved. Her gingival bleeding stopped, bruising resolved and her ulcers began to heal.
The study authors said while scurvy was once a common disease in sailors deprived of citrus fruit and vegetables, it was more recently found in “impoverished populations, people on ‘fad’ diets, alcoholics and those with psychiatric disturbances”.
They called on doctors and dieticians involved in the care of the critically ill to consider scurvy as a potential reason for their clinical manifestations.
“Furthermore, it should be recognised that scurvy may be induced or exacerbated by both the patient’s underlying disease process and treatment,” they added.
Other features of scurvy include perifollicular petechiae (around the skin’s hair follicles are small, i.e., 2mm or smaller, haemorrhages), abnormal coiled hairs, follicular hyperkeratosis (Follicular hyperkeratosis is a skin condition characterized by excessive development of keratin in hair follicles resulting in rough, cone-shaped, elevated papules. The openings are often closed with a white plug of encrusted sebum), poor wound healing and woody oedema of the lower limbs.
Internal Medicine Journal 2011