Scurvy in Adult
Scurvy is a relatively rare diagnosis in the developed world. Pathognomonic clinical findings of scurvy include gingival bleeding and perifollicular petechiae with corkscrew hairs. Other common features include vascular fragility, manifesting as purpura, petechiae, ecchymoses, and gastrointestinal bleeding. Spontaneous hemorrhage into muscles, soft tissues, and joints can cause painful hematomas and hemarthroses. Symptoms include fatigue, weakness, muscle cramping, and malaise as well as cognitive impairment and mood disturbances.
Risk factors for developing scurvy include alcohol use, low socioeconomic status, restrictive diets or dietary fads, obesity, psychiatric disease, and malabsorption due to gastrointestinal disease. Additionally, older adults, especially those in social isolation; patients on dialysis; and individuals with increased metabolic requirements (such as pregnant or lactating individuals and patients with severe infections) are at increased risk. People who chronically abuse alcohol are particularly susceptible to scurvy not only due to poor dietary intake but also decreased ascorbic acid absorption.
E54 – Ascorbic acid deficiency
76169001 – Scurvy
Differential Diagnosis & Pitfalls
- Leukocytoclastic vasculitis
- Disseminated intravascular coagulation
- Sjögren syndrome
- Idiopathic thrombocytopenic purpura
- Systemic lupus erythematosus
- Vitamin K deficiency
- Rocky Mountain spotted fever
- Solar purpura
- Ehlers-Danlos syndrome
- Waldenström macroglobulinemia
- Disorders of platelet function
- Clotting factor deficiencies
- Iatrogenic coagulopathy
- Hematologic malignancy
- Bateman purpura (senile purpura) usually occurs on the forearms and would not have the associated follicular, bone, and gum changes.