Abstract

Scurvy results from a deficiency in vitamin C (ascorbic acid), which plays a vital role in physiologic processes including collagen biosynthesis and cross-linking, iron absorption, and folate metabolism. Many clinical features of scurvy reflect impaired collagen synthesis and presentation varies (bleeding gingivae, loose teeth, cutaneous bruising, “corkscrew” hairs, perifollicular hemorrhage, arthralgias, joint edema, impaired wound healing, hematologic abnormalities). Diagnosis may be made clinically or augmented by measuring serum ascorbic acid. Historically associated with sailors’ diet lacking citrus fruit while at sea, scurvy may be more prevalent than commonly believed. Predisposing factors include dieting, substance abuse, prolonged illness, and malabsorption. Herein, we present three patients diagnosed with scurvy during the COVID-19 pandemic: (a) 53-year-old male with leg pain and spontaneous bruising; (b) 17-year-old female with generalized fatigue and anemia; (c) 68-year-old male with an itchy rash. This case series is notable because it exemplifies the variable presentation of scurvy, demonstrates that diagnosis can be made using different methods, and illustrates a potentially new predisposing risk factor (e.g. COVID-19). Because all patients were diagnosed during the pandemic, there is reason to wonder whether an association exists between the novel virus and scurvy, either through an indirect connection or via an as yet undefined viral induced process. If left untreated, scurvy may lead to not only increased morbidity and mortality, but also an extensive and costly work-up for the patient and healthcare system. Supplemental vitamin C treats the disease. It is therefore imperative to have a high index suspicion for vitamin C deficiency.

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No current or relevant financial relationships exist.