(BMJ)—A 79-yo man presented w/ 4-wk hx of skin changes on both lower extremities. Two prior courses of abx for presumed cellulitis failed to produce clinical improvement. ROS: neg. No meds. Leg exam: bilateral woody edema, w/ R leg larger than L, but calf soft/nontender; perifollicular hemorrhage; corkscrew hairs. Labs: renal panel, LFTs, B12, folate, coag panel all normal. Hgb: 11.7 mg/dL, but normal platelet count. U/S: neg for DVT. What is the dx?
Scurvy
Immune thrombocytopenic purpura
Leukocytoclastic vasculitis
Systemic lupus erythematosus
Vitamin D deficiency
You are correct. The pt had clinical findings suggestive of scurvy (vitamin C deficiency). He lived alone and consumed a diet lacking fruits and vegetables. Low ascorbic acid level was confirmed. Scurvy remains prevalent and is often unrecognized. In a U.S. study of civilians, 7.1% of the population had vitamin C deficiency. At-risk groups include the socially isolated and elderly, pts w/ alcohol dependency, some psychiatric pts, dialysis pts, and those who avoid acidic foods due to GI disturbance. Lower socioeconomic status, male sex, smoking, and obesity are also assoc w/ increased risk of deficiency. The pt was started on oral ascorbic acid, seen by a dietitian, and discharged w/ plans for community dietitian f/u. Resolution of fatigue and skin changes occurred w/in 4wk. At 6wk, his Hgb level had normalized.

BMJ 2017;356:j1013