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The cost-of-living squeeze and poor diets are putting people at a higher risk of developing scurvy, with a case caused by an acute vitamin C deficiency recently treated at Sir Charles Gairdner Hospital in Perth.
The now-rare disease is best associated with sailors' lack of fresh fruit and vegetables on long sea voyages over the centuries.
But doctors say cases of scurvy are on the rise.
"Scurvy is a re-emerging diagnosis in the current era of a rising cost of living and increasing number of bariatric surgeries," they concluded in a case report published in medical journal BMJ Case Reports.
The man, aged in his early 50s, had undergone weight loss gastric bypass surgery eight years earlier, which is a risk factor.
But doctors did not know that when he presented to them with tiny red-brown pinpoints resembling a rash on both lower legs, that he discovered after waking up and was causing him some pain and limiting his movement.
The man was admitted to Sir Charles Gairdner Hospital in Perth. (Supplied: BMJ)
He tested negative for inflammatory, autoimmune and blood disorders, and there were no signs of internal bleeding
Lead author Andrew Dermawan said scurvy was not immediately obvious.
"We don't routinely test for it because we thought we had eradicated scurvy," Dr Dermawan said.
'Renaissance-era diagnosis'
The case report described the disease as "a Renaissance-era diagnosis that is often overlooked but is easily investigated and treated".
The man's rash spread to his arms while in hospital, prompting the team to further investigate his personal circumstances.
The rash spread to the man's arms while he was in hospital. (Supplied: BMJ)
"He had financial constraints and therefore neglected his diet," the report said.
"His meals mostly comprised processed food, lacking in vegetables or fruit.
"Sometimes he would skip meals, which occurred more frequently in recent weeks.
"He had also stopped taking the vitamin and mineral supplements prescribed following gastric bypass surgery as he was unable to afford them.
"An underlying nutritional deficiency was therefore suspected."
Blood tests confirmed he had no detectable levels of vitamin C and he was diagnosed with scurvy.
Doctors put him on a dose of 100 milligrams of vitamin C per day, as well as folic acid and multivitamins.
"He also started eating a lemon daily," the report said. He started improving and was discharged with a new dietary plan and vitamin supplements.
"Our patient had multiple risk factors, namely poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors and low-income status," the doctors said.
"His history of iron, vitamin D and folate deficiencies were also clues to his underlying nutritional deficiency."
They are clear that this is not an epidemic or a sudden coming storm of scurvy.
"This is just one case report, and while it's not clear what the current prevalence of scurvy is, it's still relatively rare," they said.
Scurvy had been largely eradicated by a healthy diet but cost-of-living pressures and gastric surgeries are seeing it return. (ABC News: Clare Rawlinson)
But they are concerned by the pressures caused by the increased cost of living.
"In Australia, the rising cost of food (up 5.9 per cent in the last 12 months) is making it harder for families to afford meals," the authors noted.
"The increasing cost of living means that people are more reliant on lower-cost foods, which tend to be poor nutritional value."
Last year, public health researchers in Victoria also raised the alarm rising cost of living pressures could open the door to scurvy and rickets.
Nutrition and dietetics professor Rebecca Golley, who leads Caring Futures Institute at Flinders University, warned that as healthy foods became less affordable there had been a resurgence of those diseases in the UK and similar problems were now emerging in Australia.
Dr Golley said Australian farmers grew more than enough vegetables to feed the nation, but on average people ate less than half the recommended five servings of vegetables a day.
Socio-economic links
Pinning down the number of cases of scurvy is elusive.
But a large-scale study of the risk factors for vitamin C deficiency in Australia was published in the Medical Journal of Australia in October 2023.
Researchers retrospectively analysed 12,934 vitamin C tests taken between 2017 and 2021
They found 45.6 per cent had vitamin C levels within the normal range, 29.9 per cent had vitamin C deficiency and 24.5 per cent had significant vitamin C deficiency.
"The proportions with significant deficiency increased with postcode‐level socio-economic disadvantage," the study found.
The authors added: "Disadvantage influences diet, including the consumption of fresh fruit and vegetables, and thereby the risk of vitamin C deficiency."
The number of overall people tested with a significant vitamin C deficiency declined each year until 2020, and the start of the pandemic.
The authors said a rise in the probability of cases from 2021 "may be related to changes in diet during COVID‐19 lockdowns, including altered consumption of fresh fruit and vegetables during this period; however, most relevant studies did not take socio-economic factors into account".
"Strategies for increasing the consumption of foods rich in vitamin C include education, national dietary guidelines, and making fresh fruit and vegetables more affordable," they said.
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