Scurvy, caused by vitamin C deficiency, is a forgotten disease in the modern era of medicine. The prevalence of vitamin C deficiency in the United States is reported to be 7.1%. We present a case of a 56-year-old man with a history of chronic alcohol use who was admitted to the intensive care unit due to sepsis. He was found to have a rash on his hands and feet which consisted of palpable lesions as well as petechiae. Work up of the patient’s skin pathology revealed ascorbic acid deficiency, also known as scurvy. This case highlights the importance of considering severe nutritional deficiency in patients with underlying alcohol use who present with skin findings that may mimic those of a vasculitis. Although rare, vitamin C deficiency still exists, and it is important to be aware of presenting signs and identify those who are at risk.
Stevens-Johnson syndrome (SJS) is a potentially life-threatening cutaneous disorder that is characterized by skin erosions. It lies on a spectrum of varying severity with toxic epidermal necrolysis (TEN) being the most severe form. An overlap of the syndromes is known as SJS/TEN. These disorders are most often caused by a drug reaction, with anti-epileptic drugs and sulfonamide drugs as the common offending agents. Rarely, the syndrome can be due to a reaction to carbonic anhydrase inhibitors such as methazolamide. When present in association with methazolamide, the syndrome has only been known to occur in patients of Asian descent with human leukocyte antigen (HLA) mutations. We present a case of methazolamide-associated Stevens-Johnson syndrome in a patient of Caucasian descent.
Lyme carditis is a rare manifestation of early disseminated Lyme disease with an incidence of 0.5% with left ventricular dysfunction and valvular involvement being exceedingly rare. Clinical manifestations typically occur 1 to 2 months after infection and include arrhythmias, conduction abnormalities, myopericarditis, and ventricular dysfunction. If left untreated, Lyme carditis can lead to acute heart failure and sudden cardiac death thus prompt diagnosis and treatment are essential in management. Here, we present a case of Lyme carditis with left ventricular dysfunction and valvular involvement occurring shortly after known tick exposure.
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