(Scurvy)

Scurvy is caused by a deficiency in  vitamin C (ascorbic acid) resulting, in the most severe cases, in tooth loss and gingivitis, bleeding and fractures. Vitamin C deficiency is also a rare but reversible cause of pulmonary arterial hypertension due to a decreased endothelial NO level and inappropriate activation of hypoxia-induced factors. Vascular lesions are due to the fact that the vitamin C is a cofactor of the synthesis of collagen. The fractures are caused by a defect in the formation of the bone matrix.

Anesthetic implications:

diagnosis to be kept in mind in the presence of severe nutrition or eating disorders (no fruits and vegetables); echocardiography (pulmonary arterial hypertension); bone fragility; risk of association with a deficiency in vitamin B1 (beriberi, see this term); risk of fractures.

References : 

-         Ichiyanagi S, Takeshita I, Kandil AI, Miyazu M, Kojima T.
Pulmonary hypertensive crisis during general anesthesia in a 3-year-old autistic boy with undiagnosed scurvy, undergoing cardiac cathererization: a case report.
A&A Practice 2019; 13: 379-81.

-        Frank BS, Runciman M, Manning WA, Ivy DD, Abman SH, Howley L.
Pulmonary hypertension secondary to scurvy in a developmentally typical child.
J Pediatr 2019 ; 208 : 291

-        Swed-Tobia R, Haj A, Militianu D, Eshach O et al.
Highly selective eating in autism spectrum disorder leading to scurvy : a series of three patients.
Pediatr Neurol 2019 ; 94 : 61-3.

-        Nariai R, Mafune R, Ide K, Nishimura N, Ono H.
Pulmonary hypertension caused by vitamin C deficiency in a 2-ear-old girl.
Pediatrics International 2022 ; 64 : e14971

Updated: May 2022