Scurvy is still present in developed countries

Abstract

Introduction: Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.

Objective: We report the case of a 57-year-old male who presented with a combined vitamin C deficiency (scurvy) and a Zinc deficiency.

Interventions: He came to the emergency department complaining of a painful swollen ecchymotic leg and dyspnea. Prescriptions for narcotics did not relieve his symptoms. When a detailed dietary history was obtained, we added scurvy to the differential diagnosis. An extensive evaluation excluded trauma, coagulopathies, neoplasia, and vasculitides.

Main result: The combination of a classic skin biopsy and a low vitamin C level confirmed the diagnosis.

Conclusion: This presentation illustrates the necessity of including scurvy in the differential diagnosis of ecchymoses and demonstrates specific populations at risk: single adults and the elderly with deficient diets.

Figure 1

Hematoma in the left thigh and perifollicular petechiae.

Figure 2

Microscopic picture showing perifollicular hemorrhage, extravasation of erythrocytes.