Not just an 18th-century sailors’ disease

Scurvy, or vitamin C deficiency, is not just an 18th-century seafarers’ disease, as a case study of a 65-year-old woman with mobility issues and social isolation shows. In an article published in Canadian Medical Association Journal, clinicians describe how scurvy should be considered in patients with abnormal bleeding and nonspecific symptoms.

The patient visited the emergency department at a downtown Toronto hospital for leg pain and weakness, skin lesions, and discoloration. She also had several chronic health conditions. Her ability to go grocery shopping, cook, and perform other activities of daily living was restricted because of mobility issues, and she had little outside support. She subsisted largely on canned soup and fish, with no fresh produce.

“This case presents a complex example of food insecurity manifesting as an uncommon diagnosis,” said Dr. Sarah Engelhart, a general internist at Mount Sinai Hospital and the University of Toronto, Toronto, Ontario. “A unifying diagnosis was uncovered only after a detailed assessment of her social and dietary history.”

Vitamin C deficiency is more common than expected in the 21st century, with a 5.9% prevalence in the United States and rates possibly as high as 25% in some groups with low socioeconomic status in the United Kingdom.

As symptoms are often nonspecific, such as fatigue, weakness, and shortness of breath, the diagnosis can be challenging.

The patient also smoked, which contributes to vitamin C deficiency. Once the patient started vitamin C treatment, her symptoms improved, and a blood test for vitamin C deficiency eventually confirmed the diagnosis.

Clinicians should be alert to vitamin C deficiency when assessing patients, including children and isolated older adults, with restrictive eating patterns (e.g., autism spectrum disorder or tea and toast diet), who smoke cigarettes, who have a substance use disorder, or who have malabsorption syndrome. The authors urge vigilance in assessing for food insecurity, which is a risk factor and affects about 1 in 5 Canadian households.