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A new study suggests that older adults experiencing abnormal bleeding, fatigue, and weakness should be evaluated for scurvy, a disease caused by vitamin C deficiency. Despite being commonly associated with 18th-century sailors, scurvy remains relevant today, especially among vulnerable populations. The study, published in the Canadian Medical Association Journal (CMAJ), reveals the importance of recognizing this condition, particularly in older adults who face challenges related to diet and mobility.

The research was centred around a case involving a 65-year-old woman in Toronto who suffered from leg pain, weakness, skin lesions, and discolouration. The woman had limited mobility due to chronic health conditions, which made it difficult for her to perform daily activities like grocery shopping and cooking. As a result, her diet consisted largely of canned soup and fish, with little to no fresh fruits or vegetables — a key factor that led to her vitamin C deficiency.

“This case presents a complex example of food insecurity manifesting as an uncommon diagnosis,” said Dr. Sarah Engelhart, a general internist at Mount Sinai Hospital and the University of Toronto. The patient's condition underscores the link between food insecurity and nutritional deficiencies, particularly in older adults.

The researchers pointed out that while scurvy is often considered a disease of the past, it is more common in the 21st century than many healthcare professionals might expect. However, diagnosing the condition can be difficult, as its symptoms are nonspecific and can be easily mistaken for other health issues. Symptoms like fatigue, weakness, shortness of breath, and abnormal bleeding are often attributed to various other conditions, which makes vitamin C deficiency an often-overlooked diagnosis.

In addition to her poor diet, the patient was also a smoker, which exacerbated her vitamin C deficiency. Smoking depletes vitamin C levels in the body, putting individuals who smoke at higher risk for the disease. Once the woman started on vitamin C supplementation, her symptoms improved significantly, and a blood test confirmed the diagnosis of scurvy.

“Clinicians should be alert to vitamin C deficiency when assessing patients, including children and isolated older adults,” emphasized the study’s authors. They urged healthcare professionals to consider scurvy as a possible diagnosis for patients with abnormal bleeding and nonspecific symptoms, particularly in those with dietary restrictions or social isolation.

The study also identified several groups of people at higher risk of developing scurvy. These include people who follow restrictive diets, such as those with autism spectrum disorder or people on a "tea and toast" diet, as well as those who smoke or have substance use disorders. Additionally, people with malabsorption syndromes, which impair the body’s ability to absorb essential nutrients, are also at increased risk.

The case study highlights the importance of a well-balanced diet rich in fresh fruits and vegetables, particularly for older adults facing mobility challenges or other barriers to accessing nutritious food.

By considering scurvy as a possible diagnosis in patients with vague symptoms, health experts can help address nutritional deficiencies that may otherwise go unnoticed, improving the quality of life for at-risk people.

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