Hypovitaminosis C (scurvy)

Dr Pir Abdul Ahad Aziz ◉ and Radswiki ◉ et al.

Scurvy is a condition caused by a dietary lack of vitamin C (ascorbic acid), hence is also
called hypovitaminosis C, and is characterized by an increased bleeding tendency and
impaired collagen synthesis resulting in osteoporosis and impaired wound healing.

Epidemiology

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.

Clinical presentation

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

Pathology

Unlike most other animals, humans cannot produce their own vitamin C.

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 fibers. Defective collagen cross-linking compromises skin, joint, bone, and
vascular integrity.

Radiographic features

Pediatric

 generalized osteopenia
 cortical thinning: “pencil-point” cortex
 periosteal reaction due to subperiosteal hemorrhage
 scorbutic rosary: expansion of the costochondral junctions
o may relate to the fracturing of the zone of provisional calcification during
normal respiration
o similar to the rachitic rosary appearance as seen in rickets
 hemarthrosis
 Wimberger ring sign: circular, opaque radiologic shadow surrounding epiphyseal
centers of ossification, which may result from bleeding
 Frankel line: dense zone of provisional calcification
  Trümmerfeld zone: lucent metaphyseal band underlying Frankel line
 Pelkin spur: metaphyseal spurs that result in cupping of the metaphysis
 Pelkin fracture: metaphyseal corner fracture

Adults

 osteopenia
 pathological fractures

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

History and etymology

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

Infantile scurvy, historically also known as Barlow disease, is named after Sir Thomas
Barlow (1845-1945), Professor of Medicine at University College London 1895-1907 5.

Eugen Fraenkel (1853-1925),  a German pathologist, was the first person to be appointed a

full Professor of Pathology at the University of Hamburg in 1919 6,8.

Karl Francis Pelkan (1890-1992), an Austrian-American pediatrician described his

eponymous spurs in a paper published in 1925 6,7.

Differential diagnosis

 rickets
 congenital syphilis
 neuroblastoma