SCURVY - AN UNJUSTLY FORGOTTEN DISEASE

Four cases of scurvy diagnosed within a period of two years are report ed. They comprised 2 male patients with heavy nicotine and alcohol abu se, a 35-year-old woman with malnutrition due to food supplements phob ia, and a 69-year-old woman with malnutrition due to dementia and soci al isolation. All four patients were adynamic and anemic. Three patien ts showed typical dermatologic signs with hemorrhagic hyperceratosis, suffusions or corkscrew hair. Two patients complained of parodontol di sorders. Other symptoms were gastrointestinal bleeding, sicca syndrome , retinal bleeding, subdural hematoma, edema and arthralgia. Associate d disorders were folic acid and vitamin B-12 depletion in two cases, a nd nephropathy and pneumonia with pneumothorax in one case each. In al l cases the serum asorbic acid concentration was below the scorbutic l evel of 11 mu mol/l. Historical data, pathogenesis, incidence, clinica l presentation, diagnosis and therapy of scurvy are discussed. We conc lude that scurvy can be observed even in a developed country such as S witzerland at the end of the 20th century. The real incidence may be u nderestimated because symptoms are not well known and disappear rapidl y after admission because of sufficient vitamin C content in normal di et. Patients at risk are socially isolated alcoholics, old people, psy chiatric patients and diet enthusiasts. Usually scurvy occurs in conju nction with other deficiencies. Smoking and acute illness enhance asco rbic acid depletion. With a knowledge of the symptomatology of scurvy, it is easy to diagnose and treatment is simple and effective.