title: Scurvy in the present times: vitamin C allergy leading to strict fast food diet.
abstract: Scurvy results from a deficiency of vitamin C, a nutrient otherwise known as ascorbic acid. Today, scurvy is rare yet emerges in select patients. The patient reported herein developed scurvy secondary to deliberate avoidance of vitamin C-rich foods. Classic cutaneous manifestations of scurvy include follicular hyperkeratosis and perifollicular hemorrhage encompassing coiled "corkscrew" hairs and hairs bent into "swan-neck" deformities. Ecchymoses, purpura, and petechiae are also characteristically prominent. Classic oral abnormalities include erythematous, swollen gingivae that hemorrhage from subtle microtrauma.Subungual linear splinter hemorrhages may also manifest as a sign of the disease. To establish the diagnosis requirements include characteristic physical exam findings, evidence of inadequate dietary intake, and rapid reversal of symptoms upon supplementation. Although unnecessary for diagnosis, histological findings demonstrate perifollicular inflammation and hemorrhage, fibrosis, and hyperkeratosis, amongst dilated hair follicles and keratin plugging. Although citrus fruit allergies have been historically documented, ascorbic acid has not been previously reported as an allergen. Although lacking absolute certainty, this report suggests a presumed case of ascorbic acid allergy based on patient history and favorable response to ascorbic acid desensitization therapy.
authors.affiliation: Massachusetts General Hospital.
authors.forename: Tarek
authors.initials: T
authors.lastname: Shaath
authors.forename: Ryan
authors.initials: R
authors.lastname: Fischer
authors.forename: Megan
authors.initials: M
authors.lastname: Goeser
authors.forename: Anand
authors.initials: A
authors.lastname: Rajpara
authors.forename: Daniel
authors.initials: D
authors.lastname: Aires
mesh_terms: D001205:Ascorbic Acid / Q000009:adverse effects*; D001206:Ascorbic Acid Deficiency / Q000150:complications* / Q000188:drug therapy; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology*; D057140:Fast Foods / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012614:Scurvy / Q000175:diagnosis / Q000209:etiology*; D012867:Skin / Q000473:pathology*; D014815:Vitamins / Q000009:adverse effects
chemical_list: D014815:Vitamins; D001205:Ascorbic Acid