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Hemarthrosis as initial presentation of scurvy
1Arthritis Unit, Massachusetts General Hospital, Boston 02114, USA.
Insights
Scurvy, or vitamin C deficiency, is rare but can mimic other conditions. Early diagnosis and vitamin C supplementation effectively treat its bleeding and skin symptoms.
Area of Science:
- Nutrition Science
- Dermatology
- Internal Medicine
Background:
- Scurvy, a condition resulting from vitamin C deficiency, is uncommon but can present diagnostic challenges due to its varied symptoms.
- Impaired collagen synthesis is the primary mechanism behind scurvy's clinical manifestations, including bleeding and hair abnormalities.
Observation:
- A 43-year-old male presented with hemarthrosis without a prior bleeding disorder history.
- Physical examination revealed perifollicular hyperpigmentation and corkscrew hairs, indicative of scurvy.
- The patient reported a diet devoid of fruits and vegetables, correlating with a significantly low serum vitamin C level.
Findings:
- The patient's presentation, including hemarthrosis and characteristic skin and hair changes, strongly suggested scurvy.
- Laboratory results confirmed markedly decreased serum vitamin C levels.
- The diagnosis of scurvy was established based on clinical presentation, dietary history, and biochemical evidence.
Implications:
- This case highlights the importance of considering scurvy in the differential diagnosis of bleeding disorders, even in non-traditional populations.
- Prompt recognition and treatment with vitamin C supplementation can lead to rapid symptom resolution and prevent long-term complications.
- Dietary counseling and awareness of vitamin C-rich food sources are crucial for preventing scurvy recurrence.
Abstract:
Vitamin C deficiency or scurvy is a disease now rarely seen except for certain populations at risk. When it occurs, diagnosis can be difficult as it can mimic other disorders. Its manifestations are primarily due to an abnormality in collagen formation causing bleeding in the skin, joints, muscles, or gastrointestinal tract and dystrophic hair deformities. We describe a case of scurvy in a 43-year-old man who presented with new onset hemarthrosis with no history of bleeding disorder. He was found to have perifollicular hyperpigmentation and corkscrew hairs, highly suggestive of scurvy. He admitted to completely eliminating fruits and vegetables from his diet and his serum vitamin C level was markedly decreased. Treatment with daily vitamin C supplement led to relief of symptoms and resolution of skin changes.