Sir: We report a case of severe end-stage scurvy mimicking multiple organ dysfunction. In humans deprived of ascorbic acid the deficiency disease scurvy develops insidiously over months [1] and can then become life-threatening as illustrated in our observation.A 75-year old retired administrator with a past history of diabetes and ischemic heart disease was admitted to our intensive care unit for acute respiratory failure, edema of the legs, and extensive purpuric lesions. He had already been examined because of anemia, development of bruises on the legs and abdomen, and repeated epistaxis without any abnormality of the clotting tests. This anemia was not related to low plasmatic concentrations of folic acid, vitamin B 12 , erythropoietin, iron, zinc, selenium, or transferrin. At admission the patient appeared conscious but weak; his blood pressure was 80/60 mmHg, pulse was 110/min, respiration 30/min, and central venous pressure 20 mmHg. His body temperature was 36.8 C. The patient was cyanosed with pulmonary edema. Confluent purpuric plaques extended from the legs to the perineum and the flanks, but no lesions were observed on the hands, feet, or face. Laboratory tests were normal with the exception of PaO 2 [45 mmHg (FIO 2 1)], creatininemia (295 mmol/l), white-cell count (3100/mm 3 ), and hemoglobin (7.5 g/dl). Electrocardiography showed an auricular fibrillation. An echocardiogram revealed a preserved ejection fraction (62 %). Radiography showed enlargement of the heart. The patient was infused with dobutamine (up to 15 mg/kg per minute) with a moderate effect on mean arterial pressure (+ 3 %) and central venous pressure (±5 %).
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