Practice Lesson of the Week

Unrecognised scurvy

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3580 (Published 17 September 2009) Cite this as: BMJ 2009;339:b3580
  1. Clarisa T P Choh, CT2 in general surgery1,
  2. S Rai, clinical fellow 1,
  3. M Abdelhamid, research fellow1,
  4. W Lester, consultant haematologist2,
  5. R K Vohra, consultant vascular surgeon1
  1. 1Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Selly Oak, Birmingham B29 6JD
  2. 2Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH
  1. Correspondence to: C Choh clarisa.choh{at}gmail.com
  • Accepted 30 April 2009

Take a careful dietary history to exclude scurvy in patients with unexplained musculocutaneous bleeding.

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.

Case report

A 30 year old white law clerk presented to the orthopaedic team with a two week history of non-traumatic left leg swelling and bruising. It had started with pain and swelling on the medial aspect of the left knee, which progressed to extensive bruising and swelling on the posteromedial aspect of the left thigh and calf. He was a non-smoker …

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