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Rheumatic manifestations of scurvy. A report of two cases
1Rheumatology and Internal Medicine Department, Robert Debré Teaching Hospital, Reims, France.
Insights
Scurvy can manifest as bleeding into muscles and joints, even in cases of nutritional deficiency. Prompt diagnosis and ascorbic acid supplementation led to full recovery in two patients with severe dietary restrictions.
Area of Science:
- Internal Medicine
- Nutrition Science
- Hematology
Background:
- Scurvy, a condition caused by vitamin C deficiency, can present with diverse clinical manifestations.
- Bleeding into soft tissues, such as muscles and joints, is a recognized but less common symptom of scurvy.
- Dietary deficiencies, particularly the exclusion of fruits and vegetables, are the primary cause of scurvy.
Observation:
- Two distinct cases of scurvy are presented, highlighting unusual initial symptoms.
- Case 1: Hemarthrosis in the tibiotalar joint associated with an insufficiency fracture, coupled with purpura and gum hypertrophy, raised suspicion for scurvy.
- Case 2: Multiple lower limb hematomas and characteristic coiled hairs prompted the diagnosis of scurvy.
Findings:
- Both patients reported complete elimination of fruits and vegetables from their diet.
- Laboratory investigations revealed significantly low serum and urine ascorbic acid levels in both individuals.
- Clinical presentation in both cases included bleeding manifestations, specifically hemarthrosis and hematomas.
Implications:
- These cases underscore the importance of considering scurvy in patients presenting with unexplained bleeding, even with atypical symptoms.
- Early diagnosis and intervention with ascorbic acid supplementation are crucial for complete recovery.
- Dietary history, including the exclusion of vitamin C-rich foods, is a key diagnostic clue for scurvy.
Abstract:
Bleeding into the muscles and joints can be the presenting manifestation of scurvy, as illustrated by two case-reports. One patient presented with hemarthrosis of the tibiotalar joint due to an insufficiency fracture and was suspected to have scurvy based on the presence of purpura and hypertrophy of the gums with loss of teeth. In the other patient, multiple hematomas in the lower limbs were found at presentation and the presence of coiled hairs suggested the diagnosis. Both patients had completely eliminated fruit and vegetables from their diet. Low levels of ascorbic acid were found in serum and urine. A full recovery was achieved in both cases under ascorbic acid supplementation.