Review Question - QID 107613

An elderly, malnourished, cigarette-smoking male with swollen gums, bruising, and corkscrew hair is most likely suffering from vitamin C deficiency.

Though vitamin C deficiency, or scurvy, is uncommon in the developed world, cases in developing countries still exist. Typically, these cases occur in those who are very old or very young due to the inability to feed themselves properly. Since vitamin C, or ascorbic acid, is found in citrus fruits and green vegetables, deficiency in these foods or consumption of these foods with denatured vitamins (due to over-boiling) can result in deficiency. Those who smoke cigarettes have also been found to be more deficient in vitamin C.

Mandl et al. describe vitamin C along with it's pharmacology. Vitamin C plays a crucial role in various hydroxylation reactions and is also required for the hydroxylation of carnitine, which has been held responsible for the early symptoms of scurvy. In particular, the deficiency of this vitamin can result in symptoms such as swollen gums, bruising, perifollicular hemorrhage, poor wound healing, glossitis, and increased bleeding time.

Ravindran et al. present a retrospective study about the prevalence of vitamin C deficiency in patients over 60 years of age. They state that the prevalence of vitamin C deficiency was as high as 74% in parts of northern India where citrus fruits are less common. They also note that this deficiency was more pronounced in men (vs women), older men (vs younger men), and also smokers (vs nonsmokers).

Figure A shows swollen gums seen best as protrusions in between sequential teeth in the upper and lower jaw.

Incorrect Answers:
Answer 1: Iron deficiency anemia would most commonly be asymptomatic, and if serious, would present with symptoms of fatigue and shortness of breath. It would not present with glossitis or corkscrew hair.
Answer 2: Vitamin B3, or niacin, can present with glossitis, but would typically also have the "3 D's": diarrhea, dermatitis, and dementia.
Answer 4: Vitamin B12 deficiency can also present with glossitis, but it would also have physical exam signs such as numbness and parasthesias of the extremities along with ataxia.
Answer 5: Vitamin K deficiency can present with bleeding and bruising, but it would not present with the other symptoms typically associated with scurvy.