Vitamin C Deficiency in a Food Insecure Patient: A Rare Case Report

Abstract

Introduction: Scurvy is rarely seen in developed countries and is characterized by deficiency of vitamin C, which can lead to symptoms including wound impairment, bleeding manifestations, and loss of teeth. Case Description: We present a case of a 53-year-old male with a right knee hemarthrosis after a fall. The patient also noted progressively enlarging spontaneous hematomas, denying any recent trauma except for the fall to the knee. He denied family history of bleeding and clotting disorders and endorsed aspirin use in the setting of a prior stroke. He actively resided at a local shelter with limited means of transportation for routine medical care. Physical exam revealed large, firm hematomas on his bilateral lower extremities, poor dentition with spontaneous gum bleeding, and scattered petechiae on his back and feet. The patient’s diet consisted entirely of fast-food meals; he denied intake of fruits or vegetables for almost a full year. Nutritional deficiencies including ascorbic acid remained higher on the differential. Vitamin C levels returned < 0.01 indicating severe deficiency (< 0.02 is diagnostic). A bleeding disorder was ruled out based on other labs. He was treated with vitamin C, iron, thiamine, and folate supplementation. His hematomas improved significantly during the hospitalization. He was discharged on a multivitamin regimen and recommended outpatient physical therapy. Discussion: Scurvy is rare in the adult population of developed countries, and while easily treatable with an excellent prognosis, the consequences are deadly if missed. Clinicians should maintain a broad differential and consider social determinants of health in high-risk groups.