Financial stress and bariatric surgeries raise the risk of scurvy

The rising cost of living and an increase in bariatric surgery procedures in Australia could lead to a re-emergence of scurvy, according to a paper in BMJ Case Reports.

Scurvy is caused by vitamin C deficiency and was first linked to sailors during the Renaissance era, but it could be mistaken for other conditions, especially inflamed blood vessels (vasculitis), potentially risking fatal bleeding if left untreated, according to the authors — doctors from Sir Charles Gairdner Hospital, Western Australia.

The doctors treated a middle-aged man whose legs were covered with tiny painful red-brown pinpoints, resembling a rash. Blood was also present in his urine and he was anaemic. He tested negative for inflammatory, autoimmune and blood disorders, and scans revealed no evidence of internal bleeding. Similarly, a skin biopsy returned no diagnostic clues.

The rash continued to spread while the man was in hospital. Further questioning revealed that he was short of cash and neglected his diet, eating little in the way of fruit and vegetables.

He said he sometimes skipped meals altogether and had also stopped taking the nutritional supplements prescribed for him after previous weight loss surgery, because he couldn’t afford them.

Blood tests to assess his general nutritional status indicated no detectable levels of vitamin C and very low levels of other key nutrients. He was diagnosed with scurvy and treated with daily vitamin C (1000 mg), vitamin D3, folic acid and multivitamin supplements, after which his painful rash and other symptoms cleared up.

This is just one case report, and while it’s not clear what the current prevalence of scurvy is, it’s still relatively rare, the authors said.

While a diet low in nutrition, the cost-of-living crisis and bariatric surgeries are some of the key contributors, others risk factors include alcoholism, smoking, eating disorders, low household income, obesity, kidney dialysis and drugs that interfere with vitamin C absorption, such as steroids and those that curb stomach acid production (proton pump inhibitors), they highlighted.

“Our patient had multiple risk factors, namely, poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors and low-income status. His history of iron, vitamin D and folate deficiencies were also clues to his underlying nutritional deficiency,” they said.

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