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scurvy; vitamin C deficiency

Etiology: - anorexia - alcoholism - bariatric surgery [2]* * case report of obese man with alcoholism & food restriction after bariatric surgery [2] Clinical manifestations: 1) infantile form a) impaired bone growth b) irritability c) retrobulbar hemorrhage d) epistaxis e) hematuria f) purpura 2) adult form a) petechiae b) ecchymoses (bruising) c) coiled hairs d) gum changes - gingival bleeding with loss of teeth [2] e) hyperkeratosis f) congested hair follicles, perifollicular hemorrhage [4] g) Sjogren's syndrome h) dyspnea i) arthralgia j) joint effusions k) femoral neuropathy l) edema m) weakness n) neuropathy l) leg pain (ache) m) orthostatic hypotension n) progressive fatigue, depression [4] o) rapid reversal of weakness with multivitamins [2] Laboratory: - ascorbate in leukocytes (buffy coat) - ascorbate in blood - ascorbate in serum/plasma - ascorbate in urine - urine levels of little use - serum sodium: hyponatremia [2] - complete blood count: anemia (mild) Differential diagnosis: - rheumatologic disease, vasculitis [3] Management: - vitamin C or multivitamin supplementation

Related

ascorbate in specimen

General

hypovitaminosis (vitamin deficiency)

References

  1. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  2. Bennett SE, Schmitt WP, Stanford FC, Baron JM. Case 22-2018: A 64-Year-Old Man with Progressive Leg Weakness, Recurrent Falls, and Anemia. N Engl J Med 2018; 379:282-289. July 19, 2018 PMID: 30021092 https://www.nejm.org/doi/full/10.1056/NEJMcpc1802826
  3. Perkins A, Sontheimer C, Otjen JP, Shenoi S. Scurvy masquerading as juvenile idiopathic arthritis or vasculitis with elevated inflammatory markers: A case series. J Pediatr 2019 Dec 13; S0022-3476(19)31470-2 PMID: 31843213
  4. Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022