The oral manifestations of scurvy in the 21st century
DOI:
https://doi.org/10.33448/rsd-v10i12.20569Keywords:
Scurvy; Oral manifestations; Ascorbic acid; Gingivitis; Avitaminosis.Abstract
Scurvy is a vitamin deficiency historically associated with pirates and sailors that affects collagen synthesis, leading to hemorrhage, skin, and oral lesions. In the 18th century, the lack of consumption of foods rich in vitamin C was found to cause such a severe condition, whose early diagnosis increases the likelihood of a better prognosis. A 58-year-old female patient complained of fatigue, body pain, and gingival bleeding for nearly 24 months. In 2001, she was diagnosed with lupus, now in remission, and osteoporosis more recently. On clinical examination, gingivitis with spontaneous bleeding was observed, despite the patient’s good hygiene, as well as some petechiae over the body. Due to the hypothesis of a possible autoimmune dermatological disease, the patient was referred to a dermatologist, who requested a series of tests, including vitamin C dosage. The results showed a concentration below 0.25mg / dL (IR, 4 to 2.0 mg / dL), and thus the diagnosis of scurvy was established. The patient was administered vitamin C replacement and in about 3 months, the symptoms started to improve. In some cases, such as this, hospitalization is required for intravenous replacement due to bleeding risks. This case report highlights the importance of the dentist in the early diagnosis and treatment of scurvy. This condition causes oral lesions that are often confused with other more common conditions, such as gingivitis or autoimmune dermatological response. Therefore, we recommend a comprehensive physical examination and anamnesis, including dietary history.
References
Gutierrez, G. A. & Martinez-Mier, E. A. (2020). Chapter 6: Vitamins and oral health. In: Monographs in Oral Science. S. Karger AG. Monogr Oral Sci. 28:59-67. 10.1159/000455372.
Semba R. D. (2012). The discovery of the vitamins. Int J Vitam Nutr Res. 82(5):310-5.
Maxfield, L. & Crane, J. (2020). Vitamin C Deficiency (Scurvy). Stat Pearls.
Alvares, O., & Siegel, I. (1980). Permeability of gingival sulcular epithelium in the development of scorbutic gingivitis. J Oral Pathol Med. 10(1):40–8.
Kern, M. & Gardner, J. M. (2020). Mucocutaneous Manifestations of Scurvy. N Engl J Med. 382:e56.
Touyz, L. Z .G. (1984). Vitamin C, oral scurvy and periodontal disease. Sou Afric Med J. (65):838–42.
Callus, C. A., Vella, S., & Ferry, P. (2018). Scurvy is Back. Nutr Metab Insights. 11:117863881880909.
Ceglie, G., Macchiarulo, G., Marchili, M. R., Marchesi, A., Aufiero, L. R., Camillo, C. D., & Villani, A. (2019). Scurvy: still a threat in the well-fed first world? Arch Dis Child. 104(4):381-383.
Shaikh, H., Faisal, M. S., & Mewawalla, P. (2019). Vitamin C deficiency: rare cause of severe anemia with hemolysis. Int J Hematol. 109(5):618–21.
Morel, L. (2017). Immunometabolism in systemic lupus erythematosus. Nat Rev Rheumat. 13:280–90.
Likhitweerawong N., Boonchooduang N., Morakote W., & Louthrenoo O. (2021). Scurvy mimicking as systemic lupus erythematosus. BMJ Case Rep. 21; 14(6):e242958.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. UFSM.
Li, R., Byers, K., & Walvekar, R. R. (2008). Gingival hypertrophy: a solitary manifestation of scurvy. Am J Otolaryngol - Head Neck Med Surg. 29(6):426–8.
Samonte V. A., Sherman P. M., Taylor G. P., Carricato M. N., Fecteau A., Ling S. C., et al. (2008). Scurvy diagnosed in a pediatric liver transplant patient awaiting combined kidney and liver retransplantation. Pediatr Transplant. 12(3):363–7.
Crist, T. A., & Sorg, M. H. (2014). Adult scurvy in New France: Samuel de Champlain’s “Mal de la terre” at Saint Croix Island, 1604-1605. Int J Paleopathol. 5:95–105.
Constantin, M. M., Nita, I. E., Olteanu, R., Constantin, T., Bucur, S., Matei, C., et al. (2019). Significance and impact of dietary factors on systemic lupus erythematosus pathogenesis (Review). Exp Ther Med. 17(2):1085–90.
Lai, C. W., Chen, H. L., Tu, M. Y., Lin, W. Y., Röhrig, T., Yang, S. H., et al. (2017). A novel osteoporosis model with ascorbic acid deficiency in Akr1A1 gene knockout mice. Oncotarget. 8(5):7357–69.
Do Amarante, F., De Souza, S. S., Borges, V., & Feldman, C. J (2008). Study of the bone mineral density in patients with systemic lupus erythematosus before and after glucocorticoid treatment. Radiol Bras. 41(4):259–62.
Japatti, S. R., Bhatsange, A., Reddy, M., Chidambar, Y. S., Patil, S., & Vhanmane, P. (2013). Scurvy-scorbutic siderosis of gingiva: A diagnostic challenge - A rare case report. Dent Res J (Isfahan). 10(3):394–400.
Popovich D., McAlhany A., Adewumi A. O., & Barnes M. M. K. (2009). Scurvy: Forgotten But Definitely Not Gone. J Pediatr Heal Care. 23(6):405–15.
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