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Case Reports

Abstract

Scurvy is a condition resulting from vitamin C deficiency and is exceptionally rare in developed countries. 

A 35-year old woman with a history of bipolar disorder, presented to the emergency room with nausea, chest pain, difficulty with ambulation, bruising, poor appetite and pain of lower extremities. Initial workup detected profound normocytic anemia (5.7g/dl) without a clear eitiologic cause and patient was referred to a cancer center for anemia of unknown cause. CT scan revealed a subcutaneous mass in the posterior pelvic wall and a bone marrow biopsy detected mild dyspoiesis in a subset of granulocytes and megakaryocytes (~5%), suspicious but not reaching the diagnostic threshold of myelodysplastic neoplasm. The working diagnosis up to this point was anemia of unknown cause, suspicious for myelodysplastic syndrome. 

A dermatologic consult revealed perifollicular pinpoint hemorrhages, petechiae and larger ecchymoses on lower extremities and left inguinal fold. Biopsy demonstrated perifollicular hemorrhages and fibrosis with dilated hair follicles and "corkscrew" hair shafts. Integrating the clinical and pathologic findings, a diagnosis of scurvy was suggested, confirmed by a serum level of vitamin C <0.1 mg/dl (N=0.7-2.0 mg/dl). Further investigation revealed that the patient had intentionally lost 100 lbs over one year and final diagnosis was scurvy secondary to chronic malnutrition. Patient rapidly improved on vitamin C replacement therapy. 

We present this case to raise awareness of a rare but significant pitfall in the diagnosis of scurvy, especially in a contemporary context where this entity might not enter the differential diagnosis of severe anemia.