Food For Thought: An Unusual Case of Scurvy with Hemarthrosis and Musculoskeletal Symptoms

Scurvy (vitamin C deficiency) can present with a wide range of musculoskeletal manifestations that mimic rheumatologic disease. A 53-year-old man was admitted with progressive muscle weakness and dizziness and was noted to have a non-blanching rash and joint swelling. Initial evaluation raised concern for inflammatory arthritis, inflammatory myopathy, or vasculitis. Although the C-reactive protein level was elevated, an extensive rheumatologic serologic workup was unrevealing. Arthrocentesis of the knee demonstrated hemarthrosis. Further dietary history revealed severe nutritional deficiency, with intake consisting predominantly of fast food, and the serum vitamin C level was undetectable. Treatment with vitamin C supplementation led to marked clinical improvement.