2742 A Unique Presentation of Scurvy in the Modern Era

Abstract

INTRODUCTION: Although rare in modern times, scurvy can present among elderly with malabsorptive syndromes, anorexia, or ESRD requiring hemodialysis. Below is a case of a middle-aged male without typical risk factors who was diagnosed with severe ascorbic acid deficiency. The purpose of this report is to highlight the importance of proper history taking that can aid in the early diagnosis and treatment of nutritional deficiencies, thereby reducing overall cost and length of hospital stay for these patients. CASE DESCRIPTION/METHODS: A 47-year-old male with history of anxiety/depression presented with two weeks of progressively worsening bilateral lower extremity ecchymosis and aches with associated non-specific flank pain and dark yellow urine. Patient denied recent aspirin or NSAID use, trauma, and blood in stool, urine, sputum, or gums. He is an unemployed, former smoker with a penicillin allergy and no family history of bleeding disorders. He was taking bupropion and clonazepam as prescribed by his psychiatrist but was also treating his anxiety with a friend’s clonidine and HCTZ. Urine drug screen was positive for MDMA and benzodiazepine. Initial lab work revealed Hb 4.7, K 2.8, elevated ESR/CRP and D-Dimer. WBC, platelets, iron studies, creatinine kinase, fibrinogen levels, and CT abdomen/pelvis were unremarkable. Patient was transfused multiple units of blood. Extensive hematologic and rheumatologic workup over the next several days was negative. He continued to have lower extremity weakness that finally resolved after starting treatment for a serum vitamin C level of 0.0 µmol/L. Patient then revealed that he had an allergic reaction to fruit as a child. He had since eliminated all fruits and most vegetables from his diet. DISCUSSION: Ascorbic acid has a short half-life and is not stored in the body. Severe Vitamin C deficiency can be seen in extremes of age and can take up to 3 months to develop. Symptoms can range from fatigue in the early stages to anemia, bone pain, gum disease, perifollicular hemorrhages, mood changes, and convulsions in the more advanced stages. Supplementation with 1-2 g of Vitamin C for the first 3 days followed by 500 mg for the next week and 100 mg daily for the next month should result in complete recovery. The case presented is unique due to the patient’s age and lack of typical findings such as corkscrew hair and bleeding gums. Patient had a prolonged hospital course with a costly workup that could have been curtailed with attention to nutritional status on presentation.