Scurvy

Background

• Nutritional deficiency of Vitamin C (Ascorbic acid)
• Vitamin C is typically foundin fruits and vegetables.
• Vitamin C is a cofactor for hydroxylation of proline and lysine amino acids in procollagen molecules, which is required for cross-linking collagen's triple helix.
• Scurvy therefore leads to unstable collagen and collagen fragility.
  • leaking of vascular structures
    • gingival bleeding
    • petechiae
    • easy bruising
• Vitamin C is also required for the disulfide bonding in hair leading to corkscrew appearance of hair.

Clinical Features

Corkscrew hair in a patient with scurvy.

Petechiae in a patient with scurvy.

Bruising in a patient with scurvy.

Gingival bleeding in a patient with scurvy.

• Gingival bleeding
• Easy bruising
• Petechiae
• Corkscrew hair

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Vitamin deficiencies

• Vitamin A deficiency
• Vitamin B deficiencies
  • Vitamin B1 deficiency (Thiamine)
    • Beriberi
    • Wernicke-Korsakoff syndrome
  • Vitamin B3 deficiency (Pellagra)
  • Vitamin B9 deficiency (Folate)
  • Vitamin B7 deficiency (Biotin)
  • Vitamin B12 deficiency
• Vitamin C deficiency (Scurvy)
• Vitamin D deficiency (Rickets)
• Vitamin E deficiency
• Vitamin K deficiency
• Zinc deficiency
  • Acrodermatitis enteropathica

Diagnosis

Guided by clinical suspicion but confirmed with laboratory analysis of vitamin C levels.

Management

Vitamin C supplementation.

References

1. Kluesner, Nicholas and Miller, daniel. “Scurvy: Malnourishment in the land of the plenty.” The journal of emergency medicine. Vol 46. no 4. pages 530-532. 2014.
2. Maltos, andre, et al. “Scurvy in a patient with AIDS: case report.” Revista de sociedade brasileira de medicina tropical 44(1): 122-123. 2011.