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Scurvy

Dr Maxime St-Amant and Radswiki et al.

Scurvy is a condition caused by a lack of vitamin C.

Epidemiology

Scurvy is rare. Young children and older persons are predisposed to scurvy because of their diet or the overpreparation of food. It does not occur before 6 months of age, because maternal stores are maintained until then.

Males and females are equally affected.

Clinical features

Patients may present with lethargy and malaise, bone pain, bleeding tendencies (e.g. bleeding gums and impaired wound healing.

Pathophysiology

A lack of dietary vitamin C (ascorbic acid) may be related to inadequate food intake, the destruction of vitamin C in food caused by cooking and canning, or the absence of fresh fruit in the diet.

Vitamin C is essential for collagen synthesis. Defective collagen compromises skin, joint, bone, and vascular integrity.

Radiographic features

In children

generalised osteopaenia
cortical thinning : “pencil-point” cortex
periosteal reaction : due to subperiosteal haemorrhage
scorbutic rosary : expansion of the costochondral junctions. It may relate to fracturing of the zone of provisional calcification during normal respiration. Similar to the rachitic rosary appearance is seen in rickets.
haemarthroses
Wimberger's ring sign: circular, opaque radiologic shadow surrounding epiphyseal centers of ossification, which may result from bleeding
Frankel's line: dense zone of provisional calcification
Trümmerfeld zone : lucent metaphyseal band underlying Frankel's line
Pelkan spur: metaphyseal spurs which result in cupping of the metaphysis

In adults

osteopaenia
pathologic fractures

Other significant manifestations in both children and adults result from the propensity for bleeding, including intra-articular, retrobulbar and intracranial haemorrhage.