Scurvy: an often misdiagnosed condition in the modern days?

Abstract

Scurvy is a rare disease in developed countries and few cases have been reported in adults within the last years. We aimed to report and discuss a case of a 35-year-old male with a medical history of irritable bowel syndrome (IBS) who initially presented to the emergency department with complaints of right leg pain, swelling, and weakness. Physical exam revealed low degree fever associated with right knee and ankle ecchymosis and edema, in addition to a well healing laceration on the anterior tibia with hyperpigmentation. Laboratory results showed elevated inflammatory markers. Due to the high suspicion of bone or soft tissue infection, antibiotic treatment was started without improvement. Upon reassessment and closer inspection of the skin, the patient was noted to have follicular hyperkeratosis and perifollicular hemorrhage; that in combination with a restrictive diet due to IBS, raised the suspicion of scurvy. Vitamin C levels were <5 µmol/L confirming the diagnosis. The patient received intravenous vitamin C showing significant improvement and was discharged home a few days after with oral vitamin C supplementation. In conclusion, scurvy should still be suspected as a diagnostic possibility in the modern days, especially in patients with restrictive dietary patterns. Prompt management of this entity leads to favourable outcomes and prevents further complications.