Cluster of vitamin C deficiency in prisoners referred to a tertiary hospital in Northwest Ethiopia: a case report

BACKGROUND: Vitamin C deficiency, though rare, can reemerge in high-risk settings with poor dietary intake. We report three cases of vitamin C deficiency in male prisoners referred from Shedie Prison to the University of Gondar Comprehensive Specialized Hospital (UoG CSH), Ethiopia. CASE PRESENTATION: Three Ethiopian male prisoners aged 23-25 years developed progressive bilateral lower limb stiffness, gingival bleeding, weight loss, and signs of anemia after 9 months of incarceration. Their diet consisted mainly of bread and cooked legume (kik wot in Amharic) without fruits or vegetables. On arrival at UoG CSH, all had signs and symptoms of nutritional anemia and scurvy. Although serum vitamin C measurement was not available, the diagnosis was supported by the characteristic clinical feature, the shared dietary exposure among affected prisoners and the rapid clinical improvement following ascorbic acid supplementation. This case series highlights an important public health concern in prison settings. Two had bicytopenia or pancytopenia. All were treated with ascorbic acid, folate, iron, nutritional support, and physiotherapy. They improved significantly and were discharged. Although 40 inmates reportedly had similar symptoms at the prison, only these three were referred and evaluated at UoG CSH. CONCLUSIONS: These cases illustrate the persistence of micronutrient deficiency syndromes in confined populations. Tertiary care institutions must remain vigilant for preventable nutritional diseases among vulnerable groups.