A Case of Scurvy Associated With Intracerebral Hemorrhage in a Patient With Alcohol Use Disorder

Area of Science:

• Neurology
• Nutritional Science
• Internal Medicine

Background:

• Scurvy, a condition resulting from vitamin C deficiency, typically manifests with connective tissue abnormalities and diverse clinical symptoms.
• Putaminal hemorrhage is an exceptionally rare neurological complication associated with scurvy.

Observation:

• A 39-year-old male presented with unilateral limb weakness, initially diagnosed as right putaminal hemorrhage requiring surgical intervention.
• Physical examination revealed a significant bleeding tendency, poor dentition (gingivitis, caries, missing teeth), raising suspicion for scurvy.
• Patient's history included smoking, alcohol use disorder, and a poor dietary intake, consistent with risk factors for vitamin C deficiency.

Findings:

• Low plasma vitamin C concentration confirmed the diagnosis of scurvy.
• The patient experienced rapid improvement in bleeding tendency following oral nutritional supplementation, including vitamin C.
• This case underscores putaminal hemorrhage as a rare but possible presentation of severe scurvy.

Implications:

• Clinicians should consider scurvy in the differential diagnosis for patients presenting with bleeding tendencies, particularly those with inadequate dietary histories.
• Early recognition and empirical vitamin C treatment are crucial for managing scurvy and its potentially severe complications.
• This case emphasizes the importance of a comprehensive patient assessment, including nutritional status, in diagnosing unusual clinical presentations.