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An unconventional case of scurvy

European Journal of Clinical Nutrition volume 67, pages 1336–1337 (2013)Cite this article

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Unlike most animals that do not require exogenous source of ascorbic acid since they derive it by the glucose metabolism, humans lack this skill, so they need a regular dietary intake5 with the citrus fruits, green vegetables, tomatoes, and peppers being very rich in vitamin C. This latter plays a crucial role in collagen biosynthesis where it is needed for proline hydroxylation. Mature collagen, indeed, is composed of three polypeptide molecules arranged in a triple helix, which are initially synthesized as procollagen molecules. The lysyl and prolyl residues are then hydroxylated using vitamin C as a cofactor. The absence of hydroxylysyl and hydroxyprolyl residues renders the polypeptide unstable and unable to self-assemble into rigid triple helices. This defect results in blood vessel fragility and easy bruising especially on the legs where the hydrostatic pressure is highest.3 Furthermore, vitamin C acts also as a potent redox agent which further protects blood vessels by removing free radicals.1, 3 Historically, scurvy is known as an illness affecting sailors on lengthy voyages deprived of citrus fruit and vegetables, whilst more recently it has been recognized as occurring in people with low socio-economic status and in alcoholics, caused by poorly balanced diets and because alcohol decreases the absorption of vitamin C, as well as in those undergoing chemotherapy, or those with psychiatric disturbances.3, 6, 7 The singularity of our case lies in the lack of these usual risk factors, except for diarrhoea due to lymphangiectasia. However, the possibility that this protein-losing enteropathy was the cause of the severe vitamin C deficiency appeared marginal, since ascorbic acid is not protein bound in the plasma and is excreted by the kidneys.3 On the other hand, the possibility of a dangerous self-imposed dietary restriction represents a new emergency in the Western world, where a growing number of people are susceptible to food faddism, resulting in the re-emergence of forgotten nutritional deficiencies.3, 8 Scurvy is a multifaceted disease ranging from severe multiorgan disfunction9 to slight symptoms including fatigue and arthralgias.3 Its diagnosis is therefore primarily based on clinical suspicion and dietary history of inadequate vitamin C intake, and then confirmed by a rapid resolution of signs and symptoms after vitamin C supplementation.

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Acknowledgements

This study was funded by a grant from: Fondazione Celiachia Italia, project entitled: ‘Studio di possibili fattori ambientali e sviluppo di nuove strategie terapeutiche nelle complicanze della malattia celiaca’ to GRC.

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Authors and Affiliations

  1. Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy

    R Ciccocioppo, A Gallia, G Gamba & G R Corazza

  2. Department of Clinical-Surgical, Diagnostic and Paediatric Science, Institute of Dermatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy

    A Carugno

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  1. R Ciccocioppo
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  2. A Gallia
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  3. A Carugno
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  4. G Gamba
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  5. G R Corazza
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Correspondence to R Ciccocioppo.

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Ciccocioppo, R., Gallia, A., Carugno, A. et al. An unconventional case of scurvy. Eur J Clin Nutr 67, 1336–1337 (2013). https://doi.org/10.1038/ejcn.2013.181

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