Is Scurvy Making a Comeback? Two Recent Cases Highlight How the Illness Can Appear in the Modern World

Scurvy has long been associated with early seafaring explorers, who lacked access to fresh fruits and vegetables while they traveled around the globe for years at a time. But scurvy, which is caused by vitamin C deficiency, is not just a long-forgotten illness to read about in history books—in some parts of the world, it may be making a modern comeback.

Doctors recently diagnosed scurvy in two patients living in distant parts of the planet, one in Canada and one in Australia. The cases suggest doctors should be on the lookout for this historic illness, particularly among patients experiencing poverty, food insecurity and social isolation.

The human body needs vitamin C, also known as ascorbic acid, to produce collagen. Collagen is essential for healthy skin, blood vessels, bones and connective tissues—without it, the body cannot function properly. Symptoms of scurvy include swollen or bleeding gums, loose teeth, fatigue, bruising, wounds that won’t heal, skin discoloration and infections.

Writing in BMJ Case Reports in September, doctors described discovering and treating scurvy in a middle-aged man in Western Australia. Because he was low on money, the man ate very few fruits and vegetables, and he sometimes skipped meals altogether. Citing his financial struggles, he stopped taking nutritional supplements he’d been prescribed after a weight loss surgery years earlier.

Though scurvy remains rare, experts worry the man might be the “canary in the coal mine,” says Tim Senior, a physician who chairs the Royal Australian College of General Practitioners’ specific interest group on poverty and health and was not involved with the case, to the Guardian’s Natasha May.

“What they’re describing in terms of cost-of-living pressures and the inability to afford good food, I think we are seeing more of that, definitely, and that will result in probably a whole range of micronutrient deficiencies, such as scurvy,” Senior tells the Guardian.

The Australian case centers on a 51-year-old man who came to Sir Charles Gairdner Hospital in Perth with a rash on his legs. The rash was made up of tiny, reddish-brown spots that were painful. He also had blood in his urine.

Doctors ran a series of tests and scans to check for internal bleeding, as well as inflammatory, autoimmune and blood disorders. But none of their diagnostic tools offered any clues as to what was causing the man’s symptoms—and his rash kept getting worse.

Doctors learned that the man was unemployed and living alone. He’d been eating mostly processed foods, and he had begun skipping meals more frequently in the weeks leading up to his hospital visit. He underwent a weight loss surgery to shrink his stomach eight years earlier but stopped taking the nutritional supplements prescribed after the procedure, to save money.

Armed with this information, doctors ordered a new round of tests, which showed that the man had no detectable levels of vitamin C in his system. He was also low on several other important nutrients. Eventually, doctors diagnosed him with scurvy.

“We don’t routinely test for it, because we thought we had eradicated scurvy,” says study co-author Andrew Dermawan, of Sir Charles Gairdner Hospital, to the Australian Broadcasting Corporation’s Nicolas Perpitch.

Fortunately, vitamin C deficiency is easy to treat. Doctors instructed the man to take 1,000 milligrams of the nutrient each day, plus a vitamin D3 supplement, folic acid and a multivitamin. He also worked with a dietitian to come up with a healthier meal plan and began eating lemons, which are rich in vitamin C, regularly.

The prevalence of vitamin C deficiency among older people and people living in areas of socio‐economic disadvantage indicates that population assessment of vitamin C levels would be appropriatehttps://t.co/BCkdv3s6kM

— MJA (@theMJA) November 1, 2023

Doctors in Canada described a similar experience this month in the Canadian Medical Association Journal. A 65-year-old woman came to a Toronto hospital with skin lesions, leg weakness, poor mobility and gum bleeding.

She told them she had difficulty preparing meals and getting groceries, and that she had little social and family support. Her diet mainly consisted of canned soup, tuna, white bread and processed cheese. Similarly, after she began taking vitamin C supplements, her symptoms began to improve.

In both cases, “doctors didn’t initially consider scurvy,” writes Lauren Ball, a community health researcher at the University of Queensland in Australia who was not involved with either case, for the Conversation. “This was based on the premise that there is abundant vitamin C in our modern food supply, so deficiency should not occur.”

But as the two cases demonstrate, maybe doctors should rethink this assumption. Patients might be at an increased risk of vitamin C deficiency if they live in food deserts, are experiencing poverty and food insecurity, are grappling with higher costs of living or are socially isolated, Ball writes.

Scurvy has also been linked with weight loss surgeries and medications, as well as mental health conditions and eating disorders.

According to a study published in July, cases of scurvy among American children are on the rise. While doctors diagnosed 8.2 cases per 100,000 children in 2016, that number had increased to 26.7 per 100,000 by 2020. The average age of patients with scurvy was 2 years old. And in an analysis of nearly 13,000 vitamin C tests in Australia, 29.9 percent of patients had a modest deficiency and 24.5 percent had a significant deficiency.

“Really, if you’re not thinking about scurvy, then there’s no way that you’re going to be able to diagnose it,” says Sally Engelhart, an internal medicine specialist at Mount Sinai Hospital who treated the woman in Toronto, to CBC News’ Mike Crawley.

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Sarah Kuta is a writer and editor based in Longmont, Colorado. She covers history, science, travel, food and beverage, sustainability, economics and other topics.