Dr. Eric Churchill scurvy cases.JPG

Dr. Eric Churchill of Baystate High Street Health Center Adult Medicine, where doctors identified 30 cases of the rare disease scurvy, a result of vitamin C deficiency, in about four years. May 28, 2015.

(Brian Steele | MassLive.com)

SPRINGFIELD - The first patient was a schizophrenic man with an apparent skin infection.

Tests were negative. Antibiotics didn't work. Then it was discovered that the level of vitamin C in his body was dangerous.

Zero. His diet consisted entirely of white bread and American cheese.

Dr. Eric Churchill of Baystate High Street Health Center Adult Medicine said the diagnosis was unusual. The patient had scurvy, a disease that has become extremely uncommon in developed countries. He was treated with vitamin C and his symptoms improved quickly.

"Vitamic C is an essential nutrient and certainly, if you don't have it, it's not good for your health," said Churchill.

The second patient with scurvy also had documented mental health issues and complained about stomach pains. She said she ate only ice cream for six months because it was soothing. If only she had chosen rum raisin flavor, she would have gotten enough vitamin C to stave off the disease most often associated with 18th-century pirates and British sailors.

"What we found is a cluster of scurvy in a place where no one expected to see it," said Churchill, detailing how the clinic, which serves roughly 9,000 patients, identified 30 cases in about four years. "One of the tragedies is that the solution is so easy."

The disease takes a long time to manifest itself, while treatment can require just a few weeks of ingesting enough vitamin C.

Scurvy in modern times is found in war-torn countries, developing nations and other places where there has been a disruption (or long-term lack) of basic social structures. In America, cases are exceedingly rare and usually found in "very end-stage alcoholics," the elderly and malnourished children, said Churchill.

So why has it cropped up in Springfield, and why now?

"Why now" is actually easier to answer: The doctors at the High Street clinic started looking for it after those initial few cases.

It's not possible to know how many cases went undiscovered because patient symptoms, like fatigue, irritability, joint pain and bleeding gums, were attributed to other health problems common at the clinic, including extreme mental health disorders, poor dental care, limited mobility, obesity and diabetes.

And those are the same issues that often limit people's diets and can lead to nutrient deficiencies of all kinds.

"These are people who don't necessarily know how to eat well and they were never taught that you have to eat your fruits and vegetables all the time," said Churchill of the scurvy patients, who are mostly young adults who live alone and shop for their own food. "One of the biggest surprises is that this is such a low nutritional bar to hit. ... This is meeting basic nutritional requirements."

Why Springfield, then? That's tougher to answer. Churchill and his colleagues are preparing a study called a case series, which simply presents their findings without drawing any concrete conclusions. Unless the research continues, the actual reasons for this scurvy cluster can't be known for sure. For now, there are only intelligent guesses.

"The problems that exist in Springfield promote this kind of poor nutrition and poor health, and then there could be other things, as well," said Churchill. "Springfield is as medically underserved as any place I've ever been. I've worked in the Bronx."

In 2014 alone, the Mayo Clinic saw 1.3 million patients from 143 countries and all 50 states. It reported just 11 scurvy cases over the past two decades. The Springfield cluster is nearly three times that size in a population of just a few thousand people.

Churchill said there's no reason for the average person to worry.

"I'm not saying everyone should rush off and get their vitamin C levels tested," he said. "In general, this is not something that most people need to be concerned about."

He's also not recommending that doctors start asking more detailed questions about diet.

"We haven't gotten anywhere near that kind of thing. ... This is not something that's going to be widespread in the general population," said Churchill. "Our patients tend to be a lot sicker and they have fewer resources for dealing with problems and this may be yet another aspect of living in this kind of an environment that we have to consider."

Future research could focus on risk factors that include poverty and low levels of literacy. Some risk factors have been identified in the past, including smoking in men.

One sobering note about this scurvy cluster: The first case was discovered in 2010. How many people had it before then, without their doctors knowing it?

"I can't imagine that this all began as soon as we started looking for it," said Churchill. "We have no reason to suspect that it hasn't been there all along."