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A Case Report Of A Man With Confirmed Scurvy Suggests The Forgotten Disease Could Be Roaring Back

The term scurvy might conjure images of pirates or 18th century sailors. But the condition, caused by a vitamin C deficiency, often triggered by a poor diet, might actually be re-emerging.

A group of doctors in Australia described a middle-aged man who showed signs of scurvy in a study published in BMJ Case Reports. The man, who had recently undergone a bariatric weight loss surgery, had a rash that covered his legs with small red-brown pinpoints which continued to spread during his hospital stint. Doctors also detected blood in his urine, and diagnosed him with anemia. Tests for inflammatory, autoimmune, and blood disorders came up negative. There was no evidence of internal bleeding, and his skin biopsy was also normal.

After further inquiry, the researchers discovered the man had been eating poorly. He had neglected fruits and vegetables and skipped some meals altogether. He also said he couldn't afford to continue to take nutritional supplements that had been prescribed after his weight loss surgery.

The doctors ran additional blood tests and saw that he had no vitamin C in his bloodstream, and also had very low levels of other key nutrients. They treated him with daily vitamin C (1000 mg), vitamin D3, folic acid, and multivitamin supplements. Soon after, his rash and other symptoms disappeared.

The case report shows that while scurvy is indeed a rare disease today, it is still possible to develop the condition. The authors note various risk factors for scurvy in today's times including poor access to affordable, quality food and bariatric surgery, which can prevent nutrient absorption. Other conditions the authors cited include alcoholism, smoking, eating disorders, low household income, obesity, kidney dialysis, and taking drugs that interfere with vitamin C absorption, such as proton pump inhibitors, which treat acid reflux.

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

While scurvy is treatable — as seen with this case report — it is often misdiagnosed because it's seen as a thing of the past. Scurvy can present as early as a month after becoming vitamin C deficient. Thus, efficient treatment is crucial.

"Failure to treat may lead to catastrophic hemorrhage, hence, early recognition and prompt treatment are vital," the authors write.

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The Ancient Disease Scurvy Is Shockingly Making A Comeback — Here's Why

Arrrrrr you kidding?

Scurvy, a vitamin C deficiency disease that plagued sailors and pirates centuries ago, appears to be re-emerging thanks to the rising cost of living and the popularity of weight loss surgery, a new study finds.

"Scurvy is still seen as a disease of the past, especially in developed countries," Australian doctors wrote Tuesday in the journal BMJ Case Reports. "However, sporadic cases of scurvy occur, especially in the elderly, patients with alcoholism and children with psychiatric or developmental problems."

Scurvy has been prevalent throughout history. This is a picture of scurvy patients at a station for abandoned children in Russia during World War I. Bettmann Archive

The physicians, from Sir Charles Gairdner Hospital in western Australia, report the case of a 50-something unemployed ex-smoker who complained of a painful rash on both legs that seemingly came out of nowhere.

Blood was found in his urine, and he was suffering from anemia, a low red blood cell count.

Australian doctors reported the case of a 50-something unemployed Aussie who complained of a painful rash on both legs that seemingly came out of nowhere. Dermawan A, et al. BMJ Case Rep 2024

ER personnel were a bit baffled as the unidentified man tested negative for inflammatory, autoimmune and blood disorders. Scans revealed no evidence of internal bleeding, and a skin biopsy yielded no clues.

Meanwhile, his rash spread while he was in the hospital, leading to more bruising, swelling and pain in both legs.

Finally, a nutritional panel showed undetectable vitamin C levels and other nutritional deficiencies.

The doctors learned that the Aussie's "living circumstances were poor."

"He had financial constraints and therefore neglected his diet. His meals mostly comprised processed food, lacking in vegetables or fruit," the case report read. "Sometimes he would skip meals, which occurred more frequently in recent weeks. He had also stopped taking the vitamin and mineral supplements prescribed following gastric bypass surgery as he was unable to afford them."

The unidentified patient's rash worsened in the hospital as doctors discovered he had scurvy. Dermawan A, et al. BMJ Case Rep 2024

Eight years prior, the patient had undergone a sleeve gastrectomy to remove a large portion of his stomach so he could lose weight.

Upon his scurvy diagnosis, the man took 1,000 milligrams of vitamin C, 125 micrograms of vitamin D3, 5 milligrams of folic acid and a multivitamin daily.

A dietitian devised a meal plan, and the man started eating a lemon every day. His rash subsided and there was no more blood in his urine.

The study authors report that the risk factors for scurvy include poor nutrition, gastric bypass surgery, dialysis, alcoholism, psychiatric history and eating disorders.

"This disease is easily reversible with supplementation, with a dramatic response seen within 24 hours," the doctors wrote. "Failure to treat may lead to catastrophic hemorrhage, hence, early recognition and prompt treatment are vital."

Risk factors for scurvy include poor nutrition, gastric bypass surgery, dialysis, alcoholism, psychiatric history and eating disorders. Dermawan A, et al. BMJ Case Rep 2024

In the US, recent research found that the incidence of scurvy in children more than tripled from 8.2 per 100,000 cases in 2016 to 26.7 per 100,000 cases in 2020.

Patients tended to be younger, male, obese and from low-income families. Nearly 65% had been diagnosed with autism.

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Thanks for signing up! The recommended daily vitamin C intake is 90 milligrams for adult men and 75 milligrams for adult women. A medium orange has 60 to 90 milligrams of vitamin C. Getty Images

The recommended daily vitamin C intake is 90 milligrams for adult men and 75 milligrams for adult women. Pregnant and breastfeeding women, smokers, some cancer patients and those taking certain medications may need more.

Scurvy signs can appear as early as a month after consuming less than 10 milligrams of vitamin C a day, the researchers say.

Dr. Theodore Strange, chairman of medicine at Northwell's Staten Island University Hospital, said he hasn't seen a case of scurvy since medical school.

"As [the study] authors state, it is still very rare in developed countries, especially here in the USA, as many foods and supplements contain enough [vitamin C] to prevent this disease from re-emerging," Strange told The Post. "If there's any concern, a good multi-vitamin can never hurt."

New Diagnostic Blood Test For Alzheimer's Disease Targets Tau

An estimated 55 million people around the world are living with Alzheimer's Disease or another form ... [+] of dementia.

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A newly published study from Sweden unveiled a blood test capable of detecting Alzheimer's disease with 90% accuracy. Although Alzheimer's is the most common form of dementia globally, current diagnostic approaches misdiagnose more than one in four people. By measuring a specific protein, called tau, this blood test seems to accurately, and cheaply, detect key hallmarks of early neurodegeneration.

What is tau? Found exclusively in neurons, tau proteins bind to the internal skeleton-like structure of cells, known as microtubules. Tau helps microtubules distributed throughout the neuron give the cell its shape and transport nutrients and other cellular materials. Normally, only small amounts of tau can be found in the cytoplasm or the cellular fluid. Individuals with Alzheimer's, however, develop clumps of tau in the brain, a known hallmark of the disease. Although tau accumulation seems to be secondary to the appearance of beta-amyloid plaques, another protein hallmark of Alzheimer's, only tau correlates with impaired memory and other cognitive symptoms.

Alzheimer's disease belongs to a family of tauopathies, a group of neurodegenerative diseases characterized by abnormal tau. The tau gene produces six distinct isoforms, or versions, of the protein based on how the protein sequence is cut. Depending on which isoforms are affected, the accumulation of tau may present as one of more than 20 different tauopathies. Alzheimer's disease, in particular, is associated with an abnormal balance of 3R and 4R tau proteins, in which enhanced levels of 4R correlate with increased cognitive symptoms. Measuring these changes involves a complex process of tapping into the cerebral spinal fluid, a procedure not commonly used in clinical practice.

To detect Alzheimer's disease less invasively, Palmqvist et. Al instead focused on a specific form of tau: phosphorylated tau-217 or p-tau217. Previous studies have detected this protein biomarker not only in cerebrospinal fluid but also circulating in the bloodstream. Phosphorylated tau, in fact, is one of the key drivers of tauopathy in Alzheimer's disease. Normal tau becomes phosphorylated as molecular phosphate groups are attached, which changes the protein's structure. Misshapen tau proteins then clump together, forming aggregates within the cell. As the cell's clean-up crew attempts to remove the clumps, a leading theory suggests that the abnormal tau induces phosphorylation in additional proteins leading to a cascade of neurodegeneration. More tau aggregates contribute to worsening cognitive function. The key to early diagnosis, therefore, is to identify subtle changes in phosphorylated tau in time to slow the progression of memory loss.

In this study, Palmqvist et. Al recruited over 1200 individuals experiencing dementia-related symptoms. Each participant provided a blood sample and underwent standard clinical evaluations for Alzheimer's disease. When measuring the percentage of phosphorylated tau, the blood test's accuracy was greater than standard clinical evaluations alone. Investigators also found that Alzheimer's disease was more accurately detected in individuals who had already progressed to dementia, compared to those with mild cognitive decline who were less likely to have this diagnosis regardless.

Currently, measuring phosphorylated tau-217 levels offers the highest diagnostic accuracy of any Alzheimer's disease blood test. These findings bring us one step closer to a future where primary clinics can deploy a cost-effective and minimally invasive test for Alzheimer's. As ongoing studies uncover the role of tau in disease progression, investigators are hopeful that a corresponding treatment may not be too far away.

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