Review Question - QID 107781

The patient’s clinical presentation is most consistent with vitamin C or ascorbic acid deficiency, which results in a syndrome commonly known as “scurvy.” Vitamin C is important for collagen synthesis.

Common symptoms of vitamin C deficiency include fatigue, dry skin, follicular hyperkeratosis and plugging, perifollicular erythema and hemorrhaging, petechiae, lower extremity edema, subungual “splinter” hemorrhages, alopecia, corkscrew hair, gingivitis and arthralgias. Cardiorespiratory symptoms such as shortness of breath and hypotension can occur in severe deficiency. Treatment is with vitamin C supplementation.

Historically, vitamin C was commonly associated with sailors and soldiers who did not consume fruits and vegetables. As Smith, et. al reviews, vitamin C deficiency can still be found in the developed world. Risk factors include elderly age, alcoholism, current smoking, mental illness, and restricted diets. Symptoms may develop as soon as three months after starting a diet absent in ascorbic acid.

Hirschmann, et. al review that humans obtain most of their vitamin C from fruits and vegetables. Infants obtain vitamin C from breast milk. Ascorbic acid is essential for the production of mature collagen. A deficiency in vitamin C results in poor synthesis of basal laminae, media, adventitia and surrounding connective tissue, which causes perivascular edema, projection of endothelial cells into the lumen of vessels and red blood cell extravasation.

Figure A demonstrates corkscrew hair seen in scurvy.

Incorrect Answers:
Answer 1: Thiamine is an important cofactor in amino acid and carbohydrate metabolism. A deficiency may lead to Wernicke-Korsakoff syndrome and Beriberi.
Answer 2: Vitamin D is essential for maintaining calcium homeostasis and is an important regulator of bone metabolism. A deficiency in Vitamin D results in Rickets seen in children or osteomalacia.
Answer 3: There are various vitamins that are important in DNA synthesis. B12 and Folate are commonly tested and a deficiency can lead to macrocytic anemia.
Answer 5: Vitamin K is important in the hepatic production of coagulation factors II, VII, IX, X, C and S. A deficiency can increase risk of bleeding.