When a diet is followed too strictly. Scurvy - An old disease in a modern gut: A case report

Abstract

Rationale: This case highlights the importance of considering a wide range of possible diagnoses when faced with unexplained hemorrhagic symptoms. When standard investigations fail to identify a clear cause, it is essential to conduct a detailed dietary history. This can lead to the diagnosis of scurvy, a reversible vitamin C deficiency that is often overlooked in populations at risk.

Patient concerns: The patient is a 55-year-old man with well-controlled Crohn disease who presented with unexplained bilateral leg pain and extensive hematomas on his lower limbs, significantly affecting his mobility and raising concerns about a serious condition.

Diagnoses: The final diagnosis was scurvy, resulting from a chronic deficiency of vitamin C due to a severely limited diet that lacked fruits and vegetables. Initially, differential diagnoses included deep vein thrombosis and drug-induced coagulopathy. However, a physical examination revealed follicular purpura, and the identified dietary restrictions ultimately led us to the correct diagnosis and enabled effective treatment.

Interventions: Vitamin C supplementation resulted in a rapid improvement in the patient's condition.

Outcomes: The patient experienced significant recovery following vitamin C supplementation.

Lessons: This case highlights the importance of recognizing nutritional deficiencies in modern medicine, especially for patients with chronic illnesses. It demonstrates that classic diseases, such as scurvy, can still occur and be overlooked if comprehensive patient histories and thorough examinations are not conducted. Timely identification and vitamin C supplementation resulted in a rapid improvement in the patient's condition, underscoring the importance of considering nutritional factors in unexplained bleeding disorders.

Keywords: Crohn disease; bruising; case report; ecchymosis; vitamin C deficiency.

Figure 1.

(A) Picture of the lower limbs showing both edema and hematomas. (B) T1-weighted MRI without contrast showing a bilateral extensive fluid infiltration of the skin and subcutaneous tissues, extending to muscular aponeuroses. MRI = magnetic resonance imaging.

Figure 2.

Detail of the left leg showing follicular purpura.