Behind the Skin: A Rare Case of Scurvy-Associated Megaloblastic Anemia

Abstract

Scurvy, caused by vitamin C deficiency, is very rare nowadays in the developed world. Scattered cases are found in people with unusual eating habits, alcoholism, intestinal malabsorption, mental disorders, or elderly living alone. Because of its rarity, clinical presentations of scurvy, especially anemia and bleeding, are no longer well appreciated, and consequently extensive evaluation is commonly launched to pursue scurvy mimics, such as deep vein thrombosis, vasculitis, systemic coagulation disorders, and myelodysplasia. Herein, we describe the clinical manifestations and lab findings in a scurvy patient to raise awareness of this uncommon disease.

Keywords: follicular hyperkeratosis; megaloblastic anemia; perifollicular hemorrhage; scurvy; vitamin C deficiency.

Figure 1.

Histopathology of vitamin C deficiency-associated megaloblastic anemia. (A) Macrocytic red blood cells on peripheral blood smear (×1000). (B) Bone marrow biopsy shows hyperplastic marrow with megaloblastic erythroid and myeloid precursors (×400). (C) Megaloblastic erythroid and myeloid precursors on marrow aspirate smear (×1000). (D) Moderate amount of iron storage in spicules, iron staining (×400).

Figure 2.

A diagram showing the suggested mechanisms to explain the role of vitamin C deficiency in megaloblastic anemia.