Lesson of the month 1: Massive spontaneous haematomas in an elderly man

Abstract

did not drink any alcohol. Physical examination on admission revealed bilateral swellings across the medial aspects of both thighs, with overlying bruising and purpura (Fig 1a ). He was haemodynamically stable and respiratory, abdominal and neurological examinations were unremarkable. There was no palpable lymphadenopathy. His dentition was poor, with the majority of teeth absent.Blood tests showed a normocytic anaemia (haemoglobin [Hb] A 73-year-old man presented with bilateral leg pain and swelling, and no history of trauma or bleeding disorders. Clinical examination, biochemistry and magnetic resonance imaging of the thighs were suggestive of muscle haematomas. These progressed signifi cantly during the admission, requiring blood transfusion. Normal vascular anatomy on computed tomography, renal and liver function, and absence of infection made a bleeding diathesis more likely. This may be caused by coagulation defects, platelet disorders and vascular fragility. An undetectable serum ascorbic acid level confi rmed the clinical suspicion of scurvy, and administration of vitamin C resulted in rapid improvement. Our case provides a structured approach to the diagnosis of bleeding disorders and scurvy, a treatable and potentially fatal disease which is often forgotten. KEYWORDS : Muscle haematomas , scurvy , bleeding disorders Case historyA 73-year-old man of Asian origin with a background of ischaemic heart disease, hypertension and type 2 diabetes presented to our London hospital complaining of severe bilateral thigh and leg pain. He described a dull ache throughout the lower limbs, which was of gradual onset and deteriorated over a period of 5 months. This was exacerbated by movement rendering him unable to walk. There were no constitutional symptoms, history of trauma or alterations to his medications in the past year. He took no non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulant or antiplatelet agents, and there was no family history of any bleeding disorders. The patient lived alone, was previously fully independent, a non-smoker and

Plant Kingdom as Source of Vitamins

“…At present, this disease is rare but continues to exist, in particular in people affected by malnutrition. It also occurs in adults and children with mental disorders, people with bad eating habits or alcoholism, and older people without medical supervision (Agarwal et al 2015;Fiorini et al 2018;Kothari et al 2020;Marik and Liggett 2019;Urueña-Palacio et al 2018). Scurvy symptoms can be linked to a total body pool of less than 300 mg and a plasma ascorbate concentration below 10 μM (EFSA NDA Panel 2013b; Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds 2000).…”