Unrecognised scurvy

Scurvy, first described by Hippocrates, has troubled sailors and soldiers since 460 BC, and consumption of citrus fruit was shown to be a cure by James Lind, a Scottish naval surgeon.1 Scurvy is a deficiency of vitamin C and commonly occurs in people with poor social status, malnutrition, and alcoholism, especially in those with peculiar dietary habits.2 3 It is thought to be rare in the developed world, but emerging literature has shown otherwise.4 5 6 Poor vitamin C status is relatively common in the United Kingdom, especially in adults living on a low income, with a prevalence of 46% in men and 35% in women.4 Scurvy has also been described in reports from the United States,7 Canada,8 Spain,9 and Italy.10 Patients usually present with fatigue, gum swelling or bleeding, and skin discolouration.7 11 12

Here, we discuss a case of a young man who presented with unilateral leg swelling and pigmentation, in association with other symptoms such as gastrointestinal bleeding and epistaxis, which resolved after the oral administration of vitamin C.