Musculoskeletal manifestations of scurvy.
Scurvy occurs in individuals who eat inadequate amounts of fresh fruit or vegetables, often because of dietary imbalances related to advanced age or homelessness. Asthenia, vascular purpura, bleeding, and gum abnormalities are the main symptoms. In 80% of cases, the manifestations of scurvy include musculoskeletal symptoms consisting of arthralgia, myalgia, hemarthrosis, and muscular hematomas. Vitamin C depletion is responsible for structural collagen alterations, defective osteoid matrix formation, and increased bone resorption. Imaging studies may show osteolysis, joint space loss, osteonecrosis, osteopenia, and/or periosteal proliferation. Trabecular and cortical osteoporosis is common. Children experience severe lower limb pain related to subperiosteal bleeding. Laboratory tests show nonspecific abnormalities including anemia and low levels of cholesterol and albumin. The finding of a serum ascorbic acid level lower than 2.5 mg/l confirms the diagnosis. Vitamin C supplementation ensures prompt resolution of the symptoms.
Fain
Olivier
O
Internal Medicine Department, Jean Verdier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris-North University-School of Medicine, UPRES EA 3409, avenue de 14 Juillet, 93143 Bondy cedex, France. olivier.fain@jvr.ap-hop-paris.fr
D001206:Ascorbic Acid Deficiency / Q000453:epidemiology; D006801:Humans; D009140:Musculoskeletal Diseases / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D012614:Scurvy / Q000150:complications*