New onset bruising? It's time for a 'C' change

Abstract

Vitamin C deficiency is rare and has long been thought to be a disease of the previous century. Defective collagen synthesis from lack of vitamin C has been well described to result in a bleeding diathesis. Here we describe a patient with new onset bleeding disorder secondary to scurvy. A 37-year-old man, with no prior or family history of a bleeding disorder or trauma, presented with a knee haemarthrosis, extensive limb bruising and pancytopenia. A standard set of investigations for haemostatic disorders, including platelet function tests and coagulation factor assays, failed to demonstrate a cause. Further scrutiny of his diet revealed a poor intake of fresh fruit and vegetables for over a decade. Vitamin C levels were undetectable, and replacement resulted in complete resolution of all symptoms. Scurvy continues to occur in the 21st century, and vitamin C levels should be performed in patients with symptoms of bruising and bleeding who have normal platelet and coagulation factor studies.