Scurvy disease in a young Sicilian man: a case report

BACKGROUND Scurvy disease is a condition due to deficiency of ascorbid acid (vitamin C) and it is characterized by weakness, anemia, appearance of mucocutaneous hemorrhages and induration of muscles in the legs. We report a case of a young man living in the island of Sicily, Italy.
CASE REPORT A 17 years old man was admitted to our hospital for the appearance of diffused cutaneous manifestations. Cause the perception of being overweight, he began autonomously a diet and he didn't take any fruit or vegetables for several months. At admission we observed the presence of severe muscular hypotrophy associated to hematomas subcutaneous of thorax, trunk and legs. Blood examination showed a mild anemia and the reduction of serum proteins. Coagulation patterns and electrocardiography were normal. Tomography showed the presence of pericardial and pelvic effusion. Transthoracic echocardiography revealed the reduction in wall thickness and a moderate anterior and posterior pericardial effusion with normal systolic and diastolic function. The blood level of vitamin C was considerably lower than normal range. Definitive diagnosis was scurvy disease. We start treatment with ascorbic acid at maximum dose combined with hypercaloric diet. Cutaneous lesions resolved in two weeks. After five months, with normalization of ascorbic acid level and complete disappearance of cutaneous manifestations, we repeated echocardiography showing a significantly increasing left ventricular wall thickness and the reduction in pericardial effusion.
CONCLUSIONS Scurvy disease is extremely rare in Sicily where citrus fruit cultivations are extensive and typical of the island. Scurvy disease is historically linked to the era of great maritime expeditions, but it still occurs in developed countries and re-emerging in Western countries. In this case we observed a combination of cutaneous and cardiac findings probably due to combined malnutrition and vitamin C deficiency.