Hypovitaminosis C (scurvy)

Radswiki et al.

Scurvy, which in infants is also known as Barlow disease), is a condition caused by dietary lack of vitamin C and characterised by increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing.

Scurvy in adults is rare. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. It does not occur before six months of age because maternal stores are maintained until then. Males and females are equally affected.

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

Humans cannot produce their own vitamin C, unlike most of other animals.

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, acting as a coenzyme to producing cross-linking of collagen fibres. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity.

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

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

Infantile scurvy known as Barlow disease is named after Sir Thomas Barlow (1845-1945), British Royal Physician.

The term scurvy comes from various words used to describe the manifestations of the condition:  covered with scabs, diseased, scorbutic.

  • scheurbuik (Dutch)
  • scorbut (French)
  • skybjugr (Old Norse) - a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages
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Article Information

rID: 12433
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Barlow
  • Barlow's disease
  • Barlow disease
  • Scurvy

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    Figure 1: illustration of scurvy signs
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