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Scurvy—Characteristic Features and Forensic Issues

Byard, Roger W., MBBS, MD, PhD*; Maxwell-Stewart, Hamish, PhD

The American Journal of Forensic Medicine and Pathology: March 2019 - Volume 40 - Issue 1 - p 43–46
doi: 10.1097/PAF.0000000000000442
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Scurvy is a multisystem condition that arises from vitamin C deficiency. As humans cannot synthesize vitamin C, serum and tissue levels depend on bioavailability, utilization, and renal excretion. Deficiencies result in defective collagen formation with swelling of gums, leg ulceration, and bleeding manifestations. Death most often results from infection and hemorrhage. In a forensic context, scurvy may mimic inflicted injuries and may be responsible for sudden death by mechanisms that remain unclear. Cardiac failure and rhythm disturbances with chest pain, hypotension, cardiac tamponade, and dyspnea are associated with vitamin C deficiency. In addition, syncope and seizures may occur. Although far less common than in previous centuries, scurvy is still present in high-risk populations that include alcoholics, isolated elderly individuals, food faddists, institutionalized patients, those with mental illness, and those who have had bariatric surgery or with underlying gastrointestinal conditions. Scurvy should therefore be a diagnosis to consider in medicolegal cases of apparent trauma and sudden death.

From the *School of Medicine, The University of Adelaide, Adelaide, South Australia; and

School of Humanities, University of Tasmania, Hobart, Tasmania, Australia.

Manuscript received July 26, 2018; accepted September 8, 2018.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

The authors report no conflict of interest.

Reprints: Roger W. Byard, MBBS, MD, PhD, Department of Pathology, The University of Adelaide, School of Medicine, Level 3 Medical School North Bldg, Frome Rd, Adelaide 5005, South Australia, Australia. E-mail: roger.byard@sa.gov.au.

© 2019 by Lippincott Williams & Wilkins.