Abstract
Historically known to be a disease of sailors and soldiers in the seventeenth and eighteenth century, scurvy is a rare nutritional deficiency in the developed world, but it can still be seen among the alcoholics and the malnourished. We present a case of a 39-year-old alcoholic male who presented with progressive fatigue and diffuse purpuric rash with scattered ecchymosis for 2 months. Blood work was remarkable for hemoglobin of 9.1 g/dl, which further dropped to 7 g/dl over the next few days. He was then found to have hemolysis on lab work. After an extensive workup, the common causes of hemolytic anemia were ruled out, vitamin C level was checked, which interestingly resulted as 0 mg/dl. Supplementation with oral vitamin C resulted in the gradual resolution of hemolytic anemia and rash. Hemoglobin improved to 15 g/dl in 4 weeks, with normalization of vitamin C level. The clinical features of scurvy can easily be confused with conditions such as vasculitis, deep venous thrombosis, and systemic bleeding disorders. Therefore, comprehensive workup up is required prior to the diagnosis. Although rare, being a reversible condition, early diagnosis and treatment of scurvy in high-risk populations cannot be stressed enough.
Similar content being viewed by others
Abbreviations
- aPTT:
-
Activated partial thromboplastin time
- RBC:
-
Red blood cell
References
Fazio V, Flint DM, Wahlqvist ML. Acute effects of alcohol on plasma ascorbic acid in healthy subjects. Am J Clin Nutr. 1981;34(11):2394–6.
Leung FW, Guze PA. Adult scurvy. Ann Emerg Med. 1981;10(12):652–5.
Malmauret L, Leblanc J, Cuvelier I, Verger P. Dietary intakes and vitamin status of a sample of homeless people in Paris. Eur J Clin Nutr. 2002;56(4):313–20.
Fraser IM, Dean M. Extensive bruising secondary to vitamin C deficiency. BMJ Case Rep. 2009. https://doi.org/10.1136/bcr.08.2008.0750.
Reuler JB, Broudy VC, Cooney TG. Adult scurvy. Jama. 1985;253(6):805–7.
Major RH, A history of medicine. A history of medicine. Charles C. Thomas; 1954.
Lind J, A treatise on the scurvy: in three parts, containing an inquiry into the nature, causes, and cure, of that disease. A. Millar; 1757.
Smith A, Di Primio G, Humphrey-Murto S. Scurvy in the developed world. Cmaj. 2011;183(11):E752-5.
Lau H, Massasso D, Joshua F. Skin, muscle and joint disease from the 17th century: scurvy. Int J Rheum Dis. 2009;12(4):361–5.
Padayatty SJ, Levine M. New insights into the physiology and pharmacology of vitamin C. Cmaj. 2001;164(3):353–5.
Baradhi KM, Vallabhaneni S, Koya S. Scurvy in 2017 in the USA. Proc (Bayl Univ Med Cent). 2018;31(2):227–8.
Cox EV. The Anemia of Scurvy. In: Harris RS, Wool IG, Loraine JA, Thimann KV (eds). Vitamins & hormones. Cambridge: Academic Press, 1969, pp 635–652.
Goldberg A. The anaemia of scurvy. Q J Med. 1963;32:51–64.
Stefanini M, Dameshek W. The hemorrhagic disorders. New York: Grune & Stratton. Inc; 1955.
Merskey C. Survival of transfused red cells in scurvy. Br Med J. 1953;2(4850):1353–6.
Yalcin A, Ural AU, Beyan C, Tastan B, Demiriz M, Cetin T. Scurvy presenting with cutaneous and articular signs and decrease in red and white blood cells. Int J Dermatol. 1996;35(12):879–81.
Vilter RW, Woolford RM, Spies TD. Severe scurvy; a clinical and hematologic study. J Lab Clin Med. 1946;31:609–30.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Shaikh, H., Faisal, M.S. & Mewawalla, P. Vitamin C deficiency: rare cause of severe anemia with hemolysis. Int J Hematol 109, 618–621 (2019). https://doi.org/10.1007/s12185-018-02575-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12185-018-02575-w