Nejm 1986;314:892

Cause:Vit C deficiency

Pathophys:Vit C part of a coenzyme necessary for hydroxylation of proline; hydroxyproline essential and unique to collagen, hence results in a primary failure of collagen formation including osteoid, dentine, skin, etc.

Increased incidence in spring because takes 3-4 mo to develop with lack of fruit

Sx:Weakness, fatigue, bleeding gums, easy bruising, painful bones (subperiosteal bleeding); postural dizziness; "4 H's" = hemorrhages, hyperkeratosis of hair follicles, hypochondriasis, hematologic anemias of Fe or folate types

Si:Tourniquet test (BP cuff at 80 mm Hg × 5 min) results in petechiae; purpura, impalpable and perifollicular; corkscrew hairs; postural hypotension; poor wound healing; edema

Resolves with rx

Sjögren's syndrome, reversible (Nejm 1970;282:1120)

Lab: Chem:Vit C level depressed (normal = 1 mg %)

Xray:Generalized osteoporosis; heavy osteoid lines at epiphyses = cartilaginous zones of provisional calcification; calcified old subperiosteal bleeding sites

Rx:Fruits and/or vit C po 60-100 mg qd; for anticancer antioxidant effect w fewest side effects, 100-200 mg qd (Jama 1999;281:1415)