A 65-year-old woman got scurvy in Toronto. Yes, scurvy

Scurvy may seem like a relic of ancient transoceanic voyages when sailors dreaded it “more than any other disease.” The same condition that killed more than two million seafarers between the late 15th and mid-19th centuries — marked by bleeding gums, tooth loss, bruising at the lightest touch, lethargy, swollen limbs and aching joints — is still an issue doctors should watch for, says a new report published in the Canadian Medical Association Journal (CMAJ).

Not eating enough fruits and vegetables is the leading cause of scurvy (hypovitaminosis C), which results from a vitamin C deficiency. The researchers note that though there are many risk factors, doctors should have a “higher index of suspicion” in patients experiencing food insecurity or those with low socioeconomic status.

The report chronicles the scurvy diagnosis of a 65-year-old woman who visited a downtown Toronto hospital emergency room last year for leg weakness. With mobility issues and little social support, her ability to go grocery shopping and make meals was limited. The researchers note that her diet consisted of primarily nonperishable foods, such as canned soup and fish, white bread and processed cheese. She didn’t eat fresh produce or take any vitamins or supplements.

“This case presents a complex example of food insecurity manifesting as an uncommon diagnosis. A unifying diagnosis was uncovered only after a detailed assessment of her social and dietary history,” lead author Sarah Engelhart, an internal medicine specialist at Mount Sinai Hospital and an assistant professor at the University of Toronto, said in a statement.

“Although her diet alone would have predisposed her to hypovitaminosis C, cigarette smoking likely played a role as well,” the researchers wrote, which can contribute to the vitamin deficiency. Once the patient started vitamin C treatment, her symptoms improved.

The researchers note that diagnosis can be challenging because many symptoms of scurvy, such as fatigue, weakness and irritability, are general.

In addition to looking out for scurvy in patients at higher risk for vitamin C deficiency, “including pediatric patients, those who smoke cigarettes or have a substance use disorder, malabsorption syndrome, or restrictive eating pattern (e.g., autism spectrum disorder or tea and toast diet),” the researchers note that doctors should assess for food insecurity, “an equally important and ubiquitous risk factor for hypovitaminosis C.”

According to Proof, a research program studying household food insecurity in Canada, 22.9 per cent of people across provinces — amounting to 8.7 million people, including 2.1 million children — lived in a food-insecure household in 2023.

“Although hypovitaminosis C is often asymptomatic and rarely represents the primary concern for presentation to acute care, the condition should not be considered only an archaic diagnosis of 18th-century seafarers,” the CMAJ report states. “Clinicians must approach patients with undifferentiated symptoms using a careful history and broad differential, especially those at higher risk for nutrient deficiencies, including people with low socioeconomic status, or isolated older adults.”

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