Abstract
Department of Medical Education, Gundersen Medical Foundation (D.D.F.), and Infectious Disease Section, Department of Internal Medicine, Gundersen Health System (T.J.K.), La Crosse, WI. A 43-year-old man with a long history of alcohol abuse presented with altered mental status, confabulation, and rash. He had perifollicular, hyperkeratotic papules and corkscrew hairs over his forearms, thighs, and upper abdomen (Figures 1 and 2), as well as gingival bleeding. A skin biopsy specimen revealed perifollicular fibrosis associated with perifollicular hemorrhage (Figure 3) consistent with a diagnosis of scurvy. The patient was treated with 500 mg of ascorbic acid daily, and the rash resolved after 1 week of treatment. His neurologic symptoms were subsequently determined to stem from Wernicke encephalopathy, which was caused by a coexistent thiamine deficiency.
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