SCURVY: A FORGOTTEN DISEASE LEADING TO WOUND INFECTION AND SEPTIC SHOCK

Abstract

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Scurvy is a nutritional deficiency of Vitamin C, which is classically related to the ‘Age of Sail’ (1571-1862) and is considered a disease of developing countries. Here we report a patient admitted to intensive care unit (ICU) for wound infection leading to septic shock who was later diagnosed with scurvy. CASE PRESENTATION: A 63-year-old female, resident of a nursing home, having a past medical history significant for ischemic stroke with right sided residual weakness, non-verbal since her stroke for the past ten years, deep vein thrombosis on anticoagulation, was brought to the hospital for worsening encephalopathy. Her blood pressure on arrival was 80/50 mmHg, with rest of the vitals being normal. On examination, she was somnolent, having poor dental hygiene, widespread scattered petechiae on the skin, stage 3 wound on the lower back with foul smelly discharge, cold extremities with good capillary refill while having normal cardiopulmonary and abdominal examination. Lab work showed stage 2 acute kidney injury (Creatinine 1.5 mg/dl from baseline 0.7 mg/dl), sodium 154 mmol/L, INR 8.3, macrocytic anemia with hemoglobin 7.6 g/dl (baseline >10 g/dl), platelet count 37,000 K/uL (baseline >150 K/uL). CT scan of head was negative for any new or acute intracranial pathology. She was managed as per sepsis guidelines requiring blood cultures, appropriate fluid resuscitation, broad spectrum antibiotics with suspected source of sepsis being the wound infection. She required hemodynamic support with vasopressors for hypotension and was admitted to ICU. Vitamin C level was checked considering her poor dental hygiene, scattered petechiae, which came back as undetectable. She was started on optimal replacement of Vitamin C which resulted in gradual improvement of her petechiae, wound and notably her thrombocytopenia completely resolved within a week of initiation of Vitamin C. DISCUSSION: Vitamin C is essential in collagen synthesis, helping in keeping our gums, skin, bone and hair healthy. Moreover, it plays role in prostaglandin metabolism thus potentially decreasing the inflammation or even sepsis. Although considered rare nowadays, scurvy or other nutritional deficiencies can be seen in elderly population, especially people from nursing home or poor socioeconomic status. Such population is at higher risk of getting worse wounds which could result in fatal sepsis or septic shock. CONCLUSIONS: Though rare, scurvy must be kept in the differentials as it carries a higher risk of septic shock which can be fatal if not timely diagnosed and treated. Reference #1: Svirbely, J.L. and A. Szent-Gyorgyi, The chemical nature of vitamin C. Biochem J, 1933. 27(1): p. 279-85. Reference #2: Ma, N.S., C. Thompson, and S. Weston, Brief Report: Scurvy as a Manifestation of Food Selectivity in Children with Autism. J Autism Dev Disord, 2016. 46(4): p. 1464-70. DISCLOSURES: No relevant relationships by Yahya Ahmad, source=Web Response No relevant relationships by Shujaa Faryad, source=Web Response No relevant relationships by Usama Talib, source=Web Response