Most cases of vitamin C deficiency in the United States are due to dietary inadequacy in older patients and patients with alcohol use disorder. Patients with chronic illnesses such as cancer and CKD and individuals who smoke cigarettes are also at risk.
Early manifestations of vitamin C deficiency are nonspecific and include malaise and weakness. In more advanced stages, the typical features of scurvy develop. Manifestations include perifollicular hemorrhages, perifollicular hyperkeratotic papules, petechiae, purpura, splinter hemorrhages, bleeding gums, hemarthroses, and subperiosteal hemorrhages. Anemia is common, and wound healing is impaired. The late stages of scurvy are characterized by edema, oliguria, neuropathy, intracerebral hemorrhage, and death.
The diagnosis of advanced scurvy can be made clinically based on skin lesions in the proper clinical setting. Atraumatic hemarthrosis is also highly suggestive. The diagnosis can be confirmed with decreased plasma ascorbic acid levels, typically below 0.2 mg/dL.
Adult scurvy can be treated with ascorbic acid 300–1000 mg/day orally. Improvement generally occurs within days.