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Haemorrhagic Pericardial Effusion as the Presenting Symptom of Scurvy
Hajar Joulal1, Jaouad Yousfi1, Laïla Benjilali1
1Department of Internal Medicine, University Hospital Center of Mohammed VI, Marrakech, Morocco.
Insights
Haemorrhagic pericarditis can be a rare, isolated sign of vitamin C deficiency (scurvy). Early diagnosis and treatment of vitamin C deficiency are crucial for improving outcomes in patients presenting with this condition.
Area of Science:
- Cardiology
- Internal Medicine
- Nutritional Science
Background:
- Vitamin C deficiency, or scurvy, typically manifests with cutaneous signs and impaired wound healing over weeks.
- Haemorrhagic pericarditis is a rare complication of scurvy, seldom reported as an isolated presentation.
- This case presents a unique instance of haemorrhagic pericarditis as the initial indicator of vitamin C deficiency.
Purpose of the Study:
- To report a case of haemorrhagic pericarditis revealing an underlying vitamin C deficiency.
- To emphasize the importance of considering vitamin C deficiency in the differential diagnosis of unexplained haemorrhagic pericardial effusions.
- To highlight the potential for scurvy to present with atypical, severe cardiac complications.
Main Methods:
- A 56-year-old female patient presented with symptoms suggestive of cardiac tamponade.
- Diagnostic workup included imaging (ultrasound, CT scan), laboratory tests (blood cultures, coagulation profiles, autoimmune markers, tumor markers, infectious disease workup), and vitamin C level assessment.
- Therapeutic intervention involved emergency pericardiocentesis followed by high-dose vitamin C therapy.
Main Results:
- The patient presented with chest pain, dyspnea, tachycardia, hypotension, and signs of pericardial effusion.
- Pericardiocentesis yielded hemorrhagic fluid; initial workup for common causes of pericarditis was negative.
- Laboratory tests revealed a critically low vitamin C level (<3 umol/L).
- Following vitamin C repletion, the patient showed significant clinical improvement and remained asymptomatic.
Conclusions:
- Haemorrhagic pericarditis can be an initial and isolated presentation of vitamin C deficiency (scurvy).
- Vitamin C deficiency should be included in the differential diagnosis of haemorrhagic cardiac tamponade, even without typical scurvy symptoms.
- Prompt identification and management of vitamin C deficiency are vital for improving the prognosis of potentially fatal conditions like scurvy-related cardiac complications.
Introduction:
Vitamin C deficiency (or scurvy) usually takes weeks to become apparent as cutaneous signs and impaired wound healing. Haemorrhagic pericarditis remains a rare complication of scurvy, which has never been reported as an isolated condition. We report the case of a haemorrhagic pericarditis revealing a vitamin C deficiency in a 56-year-old patient.
Case Description:
A 56-year-old woman presented with a 2-week history of worsening chest pain and dyspnoea, with no significant medical history. Upon admission, the patient exhibited tachycardia, tachypnoea, low blood pressure, elevated jugular venous pressure, muffled heart sounds and multiple petechiae on her lower limbs. An ultrasound revealed a large pericardial effusion, and an emergency pericardiocentesis was performed, which yielded haemorrhagic fluid without atypical cells. An initial workup including haemoculture, PT and PTT, tuberculosis workup, autoantibodies, tumour markers and infectious disease was negative. A whole-body CT scan showed no evidence of tuberculosis or lymphoma. Additional testing showed that her vitamin C level was <3 umol/L. Following stabilisation, high-dose vitamin C therapy was initiated. Subsequently, she showed continued clinical improvement and remained asymptomatic upon her discharge.
Discussion:
While uncommon, it is crucial to investigate vitamin C deficiency when confronted with an unexplained haemorrhagic pericardial effusion, particularly in patients with risk factors.
Conclusion:
Our case highlights the significance of early detection of this condition in promptly addressing the diverse complications of scurvy, thereby enhancing the prognosis of a potentially fatal condition.
Learning Points:
Haemorrhagic pericarditis could be an initial indication of scurvy.Vitamin C deficiency must be included in the differential diagnostic of haemorrhagic tamponade, even in the absence of a typical signs and symptoms of scurvy.
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