Scurvy: A case report of rare orthopaedic complications associated with multi-nutritional deficiencies

  • Melissa Carroll Royal Melbourne HospitalThe Royal Darwin Hospital, Tiwi, Northern Territory, Australia
  • Joseph Yoon The Royal Darwin Hospital, Tiwi, Northern Territory, Australia
  • Patrick Elliott The Royal Darwin Hospital, Tiwi, Northern Territory, Australia

Abstract

Suboptimal nutrition can lead to deficiencies in micronutrients such as ascorbic acid (vitamin C), which can present with catastrophic neurological sequalae. Deficiencies of vitamin C, vitamin B3 (niacin) and zinc levels contribute to reduced bone density. Vitamin C associated vertebral fractures although rare in adults, are still treatable if diagnosed early with a thorough clinical and nutritional history and early supplementation.  Radiological clues suggestive of scurvy induced vertebral fractures can be diagnosed on plain X-ray and MRI spine imaging.

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References

  • Hercberg S, Preziosi P, Galan P, Devanlay M, Keller H, Bourgeois C, et al. Vitamin status of a healthy French population: dietary intakes and biochemical markers.Int J Vitam Nutr Res 1994;64:220-232.
  • Hampl JS, Taylor CA, Johnston CS. Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994.Am J Public Health 2004;94:870-875. doi:10.2105/ajph.94.5.870.
  • Schleicher RL, Carroll MD, Ford ES, Lacher DA. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003–2004 National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr 2009;90:1252-1263. doi:10.3945/ajcn.2008.27016.
  • Lipner S. A classic case of scurvy. Lancet 2018;392(10145):431. doi:10.1016/S0140-6736(18)31491-0.
  • Szterenlicht YM, Jarjoui A, Kurd R, Levy L, Munter G. A peculiar case of purpura. Am J Med 2019;132:934-935. doi:10.1016/j.amjmed.2019.02.047.
  • Bonsall A. Never surprise a patient with scurvy. Int J Dermatol 2017;56:1488-1489. doi:https://doi.org/10.1111/ijd.13723.
  • Colacci M, Gold WL, Shah R. Modern-day scurvy. CMAJ 2020;192:E96. doi:10.1503/cmaj.190934.
  • Joshi R, Gustas-French CN, Fanburg-Smith JC, Helm KF, Flemming D. Scurvy: a rare case in an adult. Skeletal Radiol. 2019;48:977-984. doi:10.1007/s00256-018-3069-3
  • Peterkofsky B, Gosiewska A, Kipp DE, Shah V, Wilson S. Circulating insulin-like growth factor binding proteins (IGFBPs) 1 and 2 induced in vitamin C-deficient or fasted guinea pigs inhibit IGF-I action in cultured cells. Growth Factors 1994;10:229-241. doi:10.3109/08977199409010989.
  • Hodges RE, Hood J, Canham JE, Sauberlich HE, Baker EM. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr 1971;24:432-443. doi:10.1093/ajcn/24.4.432.
  • Chen G-C, Lu D-B, Pang Z, Liu Q-F. Vitamin C intake, circulating vitamin C and risk of stroke: a meta-analysis of prospective studies. J Am Heart Assoc. 2013;2. doi:10.1161/JAHA.113.000329.
  • Vannier S, Thomas R, Jean-christophe F, Pinel JF, Verin M. Vitamin C depletion is spontaneous intracerebral hemorrhage risk factor. (S25.005). Neurology 2014;82(10 Supplement). https://n.neurology.org/content/82/10_Supplement/S25.005. Accessed 8 June 2020.
  • Nyyssönen K, Parviainen MT, Salonen R, Tuomilehto J, Salonen JT. Vitamin C deficiency and risk of myocardial infarction: prospective population study of men from eastern Finland. BMJ 1997;314:634-638. doi:10.1136/bmj.314.7081.634.
  • Padayatty SJ, Levine M. Vitamin C and myocardial infarction: the heart of the matter. Am J Clin Nutr 2000;71:1027-1028. doi:10.1093/ajcn/71.5.1027.
  • Simon JA, Hudes ES. Relation of ascorbic acid to bone mineral density and self-reported fractures among US adults. Am J Epidemiol 2001;154:427-433. doi:10.1093/aje/154.5.427.
  • Fain O. Musculoskeletal manifestations of scurvy. Jt Bone Spine 2005;72:124-128. doi:10.1016/j.jbspin.2004.01.007.
  • Uda K, Goto M, Nigo A, Kono T. Early diagnosis of scurvy based on radiology and dietary history. Pediatr Int 2017;59:357-358. doi:10.1111/ped.13183.
  • Seftel HC, Malkin C, Schmaman A, Abrahams C, Lynch SR, Charlton RW, et al. Osteoporosis, scurvy and siderosis in Johannesburg Bantu. Science 1966;936(March):1964-1965.
  • Joffe N. Some radiological aspects of scurvy in the adult. Brit J Radiol 1961;34:429-437. doi:10.1259/0007-1285-34-403-429.
  • Howland WJ, Curry JL, Buffington CB. Fulcrum fractures of the lumbar spine: transverse fracture induced by an improperly placed seat belt. JAMA 1965;193:240-241. doi:10.1001/jama.1965.03090030062025
  • Published: 2022-11-17

    Issue: 2022: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    1.
    Carroll M, Yoon J, Elliott P. Scurvy: A case report of rare orthopaedic complications associated with multi-nutritional deficiencies . EJCRIM 2022;doi:10.12890/2022_003359.