Scurvy: Symptoms, Types, Causes and Treatment

Scurvy, though often relegated to the annals of maritime history, is a modern concern that can emerge in anyone with a prolonged deficiency of vitamin C. Despite being rare in high-income countries, its ability to mimic other diseases, cause severe complications, and affect vulnerable populations—including children, the elderly, and those with restrictive diets—makes understanding scurvy crucial for both healthcare providers and the general public. This article comprehensively explores the symptoms, types, causes, and treatment of scurvy, synthesizing current research and clinical insights.

Symptoms of Scurvy

Scurvy manifests in a variety of ways, often starting subtly and progressing to more severe systemic issues if not identified and treated. Recognizing these symptoms early is vital, as prompt intervention can prevent complications and reverse the disease swiftly.

System	Key Symptom(s)	Typical Patient Group	Source(s)
Musculoskeletal	Joint pain, muscle aches	Children, adults	1 3 4 5 6 8
Skin	Bruising, petechiae, rash	All ages	2 4 5 8 10 12
Oral	Swollen, bleeding gums	Dentate patients	2 5 9 12 13
Systemic	Fatigue, malaise, anemia	All ages	2 4 5 8 11

Table 1: Key Symptoms

Musculoskeletal Symptoms

The musculoskeletal system is frequently affected, with up to 80% of patients experiencing symptoms such as arthralgia (joint pain), myalgia (muscle pain), hemarthrosis (bleeding into joints), and muscle hematomas. In children, severe lower limb pain and difficulty walking are common, often due to subperiosteal bleeding. These findings can mimic rheumatologic diseases or infections, leading to diagnostic confusion and unnecessary interventions 1 3 4 5 6 8.

Skin Manifestations

Cutaneous symptoms are among the earliest and most visible signs. These include:

• Follicular hyperkeratosis (rough, bumpy skin around hair follicles)
• Perifollicular hemorrhages (small pinpoint bleeding around hair follicles)
• Petechiae and ecchymoses (small and large bruises)
• Xerosis (dry skin)
• Poor wound healing

Such features are frequently mistaken for other dermatological or hematological disorders 2 4 5 8 10 12.

Oral and Dental Changes

Gum abnormalities are classic in scurvy, particularly in those with teeth. Symptoms include:

• Swollen, spongy, purple gums
• Gum bleeding
• Tooth loosening or loss

These oral signs are sometimes severe, leading to significant periodontal disease and even tooth loss, especially in advanced cases 2 5 9 12 13.

Systemic and Constitutional Symptoms

Scurvy can cause generalized symptoms that include:

• Profound fatigue and malaise (often the earliest sign)
• Irritability (especially in children)
• Loss of appetite
• Severe anemia
• Edema (swelling, often in the legs)
• Syncope (fainting) and, rarely, sudden death

These constitutional symptoms, coupled with the specific findings above, can help guide clinicians toward the correct diagnosis 2 4 5 8 11.

Types of Scurvy

While scurvy is fundamentally a disease of vitamin C deficiency, its presentation can vary by age, underlying health status, and specific risk factors. Understanding these types can assist in timely diagnosis and targeted prevention.

Type	Defining Features	At-Risk Group	Source(s)
Pediatric	Bone pain, irritability	Children, ASD, disabilities	5 6 8
Adult	Fatigue, bleeding, anemia	Elderly, isolated adults	2 9 11 13
Secondary	Linked to comorbidities	GI disease, alcoholism	2 11 13
Atypical/Misdiagnosed	Mimics other diseases	All ages	3 4 5 8 10

Table 2: Types of Scurvy

Pediatric Scurvy

Children, particularly those with restrictive or selective eating habits—such as those with autism spectrum disorder, developmental delay, or physical disabilities—are at risk. Their symptoms often center on musculoskeletal pain (limping, refusal to walk), irritability, and mucocutaneous signs. Misdiagnosis is common, and cases may initially be mistaken for vasculitis, infections, or neoplasia 5 6 8.

Adult Scurvy

In adults, scurvy frequently presents with fatigue, anemia, bleeding tendencies (bruising, gum bleeding), and poor wound healing. Elderly individuals and those experiencing social isolation, psychiatric illness, or alcoholism are especially vulnerable. The disease may go unrecognized until advanced stages, especially in developed countries 2 9 11 13.

Secondary Scurvy

This type occurs in the presence of underlying medical conditions that impair vitamin C absorption or increase its loss, such as gastrointestinal disorders (Crohn's disease, post-surgery), or chronic illnesses like alcoholism. These patients may present with both classical scurvy features and symptoms related to their comorbidities 2 11 13.

Atypical or Misdiagnosed Cases

Scurvy is renowned for its ability to mimic other diseases:

• Autoimmune disorders (vasculitis)
• Rheumatologic diseases (arthritis)
• Hematologic or oncologic diseases

This mimicry leads to extensive, sometimes invasive, testing before the true diagnosis emerges. A rapid response to vitamin C supplementation is often diagnostic in such cases 3 4 5 8 10.

Causes of Scurvy

At its core, scurvy results from a prolonged and severe deficiency of vitamin C (ascorbic acid). However, the reasons for this deficiency are multifaceted, involving dietary, genetic, and medical factors.

Cause Type	Mechanism/Description	Who's at Risk	Source(s)
Dietary	Low intake of fruits/vegetables	Elderly, children, poor	1 2 5 6 8 9
Genetic	Inability to synthesize vitamin C	All humans	7
Medical	Malabsorption, chronic illness, medications	GI disease, alcoholics	2 11 13
Social	Isolation, psychiatric illness, homelessness	Isolated, marginalized	2 4 9 13

Table 3: Causes of Scurvy

Dietary Deficiency

Humans are unique among most animals in that we cannot synthesize vitamin C internally and must obtain it through diet, especially from fresh fruits and vegetables. Prolonged absence or severe restriction of these foods is the most common cause of scurvy worldwide. This is especially true for:

• Elderly persons with limited access to fresh food
• Children with restrictive eating patterns
• Individuals living in poverty or experiencing homelessness
• People following extreme diets 1 2 5 6 8 9

Genetic Basis

The inability to produce vitamin C is due to the absence of the liver enzyme L-gulonolactone oxidase, a genetic defect shared by all humans and some primates. This inherited metabolic error, termed "hypoascorbemia," underpins our absolute dietary requirement for vitamin C. Without supplementation, this leads to scurvy 7.

Medical Conditions and Medications

Certain medical conditions can lead to secondary vitamin C deficiency:

• Gastrointestinal disorders (e.g., Crohn's disease, post-GI surgery) causing malabsorption
• Chronic alcoholism, which impairs nutrient absorption and intake
• Prolonged use of certain medications (e.g., proton-pump inhibitors) that may affect absorption or increase requirements 2 11 13

Social and Psychiatric Factors

Mental health disorders, social isolation, and homelessness can all impede access to a balanced diet, increasing the risk of scurvy. Psychiatric conditions, especially those affecting eating behavior, are increasingly recognized as contributors 2 4 9 13.

Treatment of Scurvy

The treatment of scurvy is both simple and highly effective, centering on vitamin C supplementation and addressing underlying causes. Rapid recognition and intervention can prevent morbidity and even mortality.

Treatment	Approach/Details	Outcome/Efficacy	Source(s)
Vitamin C	Oral or IV supplementation	Rapid symptom reversal	1 2 4 5 9 11 12 13
Diet Correction	Increase fruits/vegetables	Prevents recurrence	1 2 9 12
Address Underlying	Treat comorbidities/social issues	Sustained recovery	2 4 11 13

Table 4: Treatment Approaches

Vitamin C Supplementation

• Oral supplementation is the mainstay, with typical doses ranging from 250 mg to 2,000 mg daily, depending on severity and absorption capacity.
• Intravenous vitamin C may be necessary in severe cases or when malabsorption is present.
• Dramatic improvement is often seen within days, with constitutional symptoms resolving quickly and musculoskeletal or dental manifestations improving over weeks 1 2 4 5 9 11 12 13.

Dietary Modification

Long-term prevention hinges on dietary counseling and ensuring regular intake of vitamin C-rich foods (citrus fruits, strawberries, tomatoes, leafy greens, etc.). This is crucial in at-risk populations 1 2 9 12.

Management of Underlying Factors

Addressing any contributing medical, social, or psychiatric issues is essential for sustained recovery:

• Treat mental health disorders or provide social support
• Manage chronic illnesses or correct malabsorption syndromes
• Educate about nutrition and access to healthy foods 2 4 11 13

Conclusion

Scurvy remains a relevant diagnosis, especially in certain at-risk populations. Its wide array of symptoms, potential for misdiagnosis, and rapid reversibility with treatment make awareness and early recognition vital.

Summary of Key Points:

• Early symptoms include fatigue, musculoskeletal pain, skin changes, and gum disease 1 2 4 5 8.
• Types of scurvy vary by age and risk factors, with children and adults presenting distinct patterns 5 6 8 9 11 13.
• Primary cause is dietary deficiency, but genetic, medical, and social factors play significant roles 1 2 5 6 7 8 9 11 13.
• Treatment with vitamin C is safe, effective, and often rapidly curative 1 2 4 5 9 11 12 13.
• Prevention depends on maintaining a balanced diet and addressing underlying risk factors 1 2 9 12 13.

Staying vigilant to the possibility of scurvy—especially in vulnerable groups—ensures that this ancient disease remains a preventable and swiftly treatable condition in modern medicine.