title: Scurvy: a new problem for patients with chronic GVHD involving mucous membranes; an easy problem to resolve.
abstract: Vitamin C deficiency in developed countries is typically observed in patients with unique clinical conditions such as cystic fibrosis or anorexia nervosa, or in patients on long-term tube feeds. We report here a clinical observation in six pediatric and adolescent patients (median age 17.5 yr, range 9.8-23.5 yr) with chronic GVHD with mucous membrane involvement found to be vitamin C deficient. These patients' baseline serum vitamin C levels ranged from <0.12 to 0.94 mg/dL (normal value 0.20-1.90 mg/dL), with a mean level 0.56 ± 0.36 mg/dL and a median level 0.6 mg/dL. Among these patients, signs and symptoms of mucositis failed to respond to standard chronic GVHD therapy. After receiving treatment with 2000 mg of ascorbic acid by mouth, daily patients displayed increased serum vitamin C levels. Clinically, this correlated with a remarkable improvement in patients' mucositis and ability to eat.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Morris
authors.initials: M
authors.lastname: Kletzel
authors.forename: Kim
authors.initials: K
authors.lastname: Powers
authors.forename: Meghan
authors.initials: M
authors.lastname: Hayes
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001205:Ascorbic Acid / Q000097:blood / Q000627:therapeutic use*; D001206:Ascorbic Acid Deficiency / Q000150:complications; D002648:Child; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D052016:Mucositis / Q000628:therapy*; D009092:Mucous Membrane / Q000473:pathology*; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D011241:Prednisone / Q000627:therapeutic use; D012614:Scurvy / Q000150:complications* / Q000628:therapy*; D033581:Stem Cell Transplantation; D055815:Young Adult
chemical_list: D001205:Ascorbic Acid; D011241:Prednisone
keywords: chronic graft vs. host disease; mucositis; scurvy