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Three Cases of Scurvy Highlighted in New Report — Donovan Hair Clinic


Diagnosis of Scurvy Requires attention to Clinical and Historical Features

Vitamin C deficiency is seen in 3-8 % of the North American Population. The cuts off levels to define vitamin D insufficiency are  ≤23–28 µmol/L ((≤0.6 mg/dL) and ≤11 µmol/L (≤0.2mg/dL) for vitamin C deficiency.

For review of vitamin C deficiency and insufficiency , please see

VITAMIN C DEFICIENCY: A REVIEW FOR THE HAIR LOSS SPECIALIST

Tembunde et al 2022

Authors of a new publication report 3 patients with scurvy. These were adults patients and the authors describe how their histories of homelessness, food insecurity, and poor nutrition made them vulnerable to restrictive diets and at increased risk for scurvy.  

PATIENT 1 was a 35-year-old man with a history of homelessness for the past several years with minimal access to food. He presented to the emergency department (ED) with diffuse body pains and lower extremity purpura. He was noted to be severely malnourished (body mass index 13.29kg/m2) and had generalized muscle wasting. Examination of his lower extremities showed perifollicular purpura. Laboratory testing showed normocytic anemia (Hemoglobin 9.8g/dL). Plasma ascorbic acid concentration was low at 0.1 mg/dL (normal 0.6 to 2 mg/mL) Within 2 weeks of initiating 1000mg oral daily vitamin C supplementation, the patient’s vitamin C concentration normalized, and the lower extremity purpura resolved.

Clinical findings from patient 1 with non-blanching perifollicular purpura on bilateral lower extremities. From Tembunde Y et al. Scurvy: A Diagnosis Not to Be Missed. Cureus. 2022 Dec 28;14(12):e33050. Used with creative commons license.

 

PATIENT 2 was a 30-year-old man presented to the ED with a 1 month history of a  lower extremity rash on both legs that ultimately spread to the thighs. He also confirmed to his doctors that he reported lower back pain, right knee pain, and bruising around the time of the rash presentation. Painful bleeding gums were also reported.  He was given a 2-week course of doxycycline and prednisone by the emergency department as scurvy was not recognized.  The patient was then evaluated by a dermatologist at a later date where scurvy was first suspected. He was noted to have scattered non-blanching folliculocentric hyperkeratotic red papules and scattered “corkscrew” hairs. A skin biopsy weas taken from the right lower leg and showed typical features of scurvy. There was a hyperkeratotic stratum corneum with perifollicular and peribulbar extravasation of erythrocytes, and a scant nonspecific superficial perivascular mononuclear infiltrate.  His ascorbic acid concentration was noted to be low (<0.1 mg/dL) and his hemoglobin was also low (8.0 g/dL) were low. He was promptly started on 1000 mg of oral vitamin C supplementation daily but was lost to follow-up.

Clinical findings from Patient 2 showing folliculocentric hyperkeratotic petechial papules and scattered corkscrew hairs. From Tembunde Y et al. Scurvy: A Diagnosis Not to Be Missed. Cureus. 2022 Dec 28;14(12):e33050. used with creative commons license.

Histology findings from patient 2. Biopsy showed stratum corneum hyperkeratosis with perifollicular erythrocyte extravasation and a scant superficial perivascular mononuclear infiltrate From Tembunde Y et al. Scurvy: A Diagnosis Not to Be Missed. Cureus. 2022 Dec 28;14(12):e33050. used with creative commons license.

PATIENT 3 was a 52-year-old woman who presented to the dermatology team for evaluation of bilateral lower extremity purpura, joint pain, decreased mobility, and skin fragility on the upper arms. The patient indicated that her diet had been limited due to dental pain. Her skin exam showed non-blanching folliculocentric petechial lesions of both legs up to thighs and purpuric macules that coalesced into erythema on both feet.

Laboratory blood tests showed an anemia (11.4g/dL), and a deficient serum ascorbic acid concentration was noted (<0.1mg/dL). The patient was treated with 1000mg of oral vitamin C supplementation daily. At a follow-up appointment  2 months later, her serum ascorbic acid level was normal. Her lower extremity skin findings resolved and the patient reported that her joint pain and mobility were improving.

Clinical findings from patient 3 showing with non-blanching folliculocentric hyperkeratotic petechial papules on bilateral lower extremities. Tembunde Y et al. Scurvy: A Diagnosis Not to Be Missed. Cureus. 2022 Dec 28;14(12):e33050.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss.
To schedule a consultation, please call the Whistler office at 604.283.1887




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