MEDICAL HISTORY
Ancient Greek disease that causes fatal bleeding and horror rash ‘re-emerges’ amid cost-of-living crisis
As it's a disease of the past, it may be mistaken for other conditions
A DISEASE first reported in Ancient Greek and Egyptian times is making a comeback, doctors have warned.
The cost of living crisis and a rise in weight loss surgeries could be factors in its return.
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Scurvy is a condition caused by a lack of vitamin C found in fresh fruit and veg.
The condition is typically associated with sailors enduring long voyages during the Middles Ages.
But doctors in the journal BMJ Case Reports have suggested it's now re-emerging.
Doctors say it's "eminently" treatable, but because it's a disease associated with the past, it could be mistaken for other conditions.
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For example, it can be confused with inflamed blood vessels (vasculitis), putting people at risk of fatal bleeding if left untreated.
Signs can appear as early as a month after a daily intake of less than 10mg of vitamin C.
According to the NHS, scurvy symptoms include:
- feeling very tired and weak all the time
- feeling irritable and sad all the time
- joint, muscle or leg pain
- swollen, bleeding gums (sometimes teeth can fall out)
- developing red or blue spots on the skin, usually on the legs and feet, although this may be less noticeable on brown or black skin
- skin that bruises easily
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Recent case of scurvy
The warnings come as doctors in Australia recently treated a man in his early 50s with the condition.
They said his legs were covered with tiny painful red-brown pinpoints, resembling a rash.
What healthy looks like
Blood was also present in his urine and he was anaemic.
He tested negative for inflammatory, autoimmune and blood disorders, and scans revealed no evidence of internal bleeding.
A skin biopsy also returned no diagnostic clues. But his rash continued to spread while he was in hospital.
Dr Andrew Dermawan, of , Western Australia, said: "Further questioning revealed that he was short of cash and neglected his diet, eating little in the way of fruit and vegetables.
"He said that he sometimes skipped meals altogether.
"He had also stopped taking the nutritional supplements prescribed for him after previous weight loss surgery, because he said he couldn't afford them."
Blood tests to assess his general nutritional status indicated no detectable levels of vitamin C and very low levels of other key nutrients.
He was diagnosed with scurvy and treated with daily vitamin C (1000 mg), vitamin D3, folic acid and multivitamin supplements, after which his painful rash and other symptoms cleared up.
Dr Dermawan said it was just one case, and while it's not clear what the current prevalence of scurvy is, it's still relatively rare.
He said: ";Scurvy is still seen as a disease of the past, especially in developed countries.
"The rising cost of living also makes it harder for families to afford good quality nutritious foods, while there have been numerous reports of scurvy arising from complications following bariatric surgery."
Other risk factors
Dr Dermawan said other risk factors for scurvy include alcoholism, smoking, eating disorders, low household income, obesity, kidney dialysis, and drugs that interfere with vitamin C absorption, such as steroids and those that curb stomach acid production, known as proton pump inhibitors.
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He added: "Our patient had multiple risk factors, namely poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors and low-income status.
"His history of iron, vitamin D and folate deficiencies were also clues to his underlying nutritional deficiency."
What is scurvy and are you at risk?
Scurvy describes severe vitamin C deficiency, and until now has been considered rare.
The condition is caused by not having enough vitamin C in your diet over a long period of time, with vitamin C mainly found in fruit and vegetables.
The NHS says you could be at risk of scurvy if:
- have no fresh fruits or vegetables in your diet for a while
- eat very little food at all – possible reasons include treatments that make you feel very sick all the time (such as chemotherapy) or an eating disorder such as anorexia
- smoke, as smoking reduces how much vitamin C your body gets from food
- have a long-term dependency on drugs or alcohol that affects your diet
- have a poor diet while pregnant or breastfeeding, because the body needs more vitamin C at these times
Babies, children and older people who find it hard to have a healthy diet may also be more at risk of scurvy.
If you think you or your child is at risk of scurvy, see a GP.
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