Scurvy: A cutaneous clinical diagnosis

Nguyen, Roland T. D.; Cowley, David; Muir, James

doi:10.1046/j.1440-0960.2003.00637.x

Cited by 36 publications

(34 citation statements)

References 18 publications

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“…The only obvious sign on admission that might have suggested scurvy was gingivitis. However, gingivitis is seen number of diseases, including Sjogren's syndrome, systemic vasculitis, periodontal disease, and blood dyscrasias [8,10]. Despite performing endoscopy and other laboratory tests, we could not explain his odynophagia and ileus.…”

Section: Discussionmentioning

confidence: 97%

Scurvy in a Patient with Depression

et al. 2007

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Section: Discussionmentioning

confidence: 97%

Scurvy in a Patient with Depression

et al. 2007

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“…Anaemia is seen in 75% of patients with scurvy and can be secondary to blood loss and concurrent folate and iron deficiency. 7 Skin biopsy is often not required as the clinical features, along with low vitamin C levels, are sufficient to make the diagnosis. Histopathology might show dystrophic hair with follicular hyperkeratosis and red cell extravasation within the perifollicular dermis (fig 4).…”

Section: Discussionmentioning

confidence: 99%

A historic disease still prevalent today

Mitchell

Wilson

Holmes

2017

BMJ

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“…1 However, these findings were overshadowed by severe pulmonary hypertension, right ventricular dysfunction, and congestive hepatomegaly. These complications were well known to physicians hundreds of years ago, when Scurvy was a devastating illness.…”

Section: Discussionmentioning

confidence: 99%

Reversible Right Heart Failure in Scurvy Rediscovery of an Old Observation

Abbas

Sterns

et al. 2016

Circ: Heart Failure

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A previously healthy 50-year-old woman presented with 3 months of progressively worsening shortness of breath associated with extreme fatigue, anorexia, a 5 to 10 pound weight loss, yellowing of her eyes, heavy menstrual bleeding, and a lower extremity rash. She denied recent trauma.She had never been admitted to the hospital before and had no history of surgical procedures. She took no medications. There was no significant family history. She was a housewife who had worked in the past as a secretary and had never smoked, drank alcohol, or used recreational drugs.Physical examination revealed blood pressure 91/56 mm Hg, heart rate 92/min, respiratory rate 20/min, and temperature 37°C. Oxygen saturation was 85% on room air. Her skin and conjunctiva were pale, and scleral icterus was present. Her neck veins were distended to her earlobes when sitting, and there was massive hepatomegaly. A nonconfluent, nonblanching petechial rash was noted on her anterior legs ( Figure 1A and 1B), and there was a large ecchymosis on her thighs and buttocks (Figure 2).Laboratory data showed severe normocytic anemia with hemoglobin 3.4 g/dL, hematocrit 12%, mean corpuscular volume 90 fL, reticulocyte count 9.7%, serum iron 9 µg/dL, total iron binding capacity 271 µg/dL, and ferritin 147 ng/mL. lactate dehydrogenase was 1117 U/L, haptoglobin (109 g/L) was normal, and direct Coombs was negative. Liver function tests were abnormal with aspartate transaminase 726 U/L, alanine transaminase 670 U/L, alkaline phosphatase 154 U/L, direct bilirubin 1 mg/dL, indirect bilirubin 4.2 mg/dL, and international normalized ratio 2.2. The viral hepatitis panel was nonrevealing. Serum acetaminophen and salicylate levels were undetectable and urine drug screen was negative. anti-neutrophil cytoplasmic antibody and anti smooth muscle antibody tests were negative, and complement levels were normal. Tissue transglutaminase and immunoglobulin A were negative. Serum lactate was 4.2 mmol/L, and B-type natriuretic peptide was elevated (347 pg/mL).An ECG revealed normal sinus rhythm with low voltage in the anterioinferior leads. A computerized tomography scan of her abdomen-pelvis showed periportal edema with hepatosplenomegaly, an enlarged inferior vena cava, portal vein, and splenic vein (Figure 3).Echocardiogram showed enlarged right atrium and right ventricle, septal flattening, right ventricular moderate hypokinesis, and mild-to-moderate tricuspid valve regurgitation without systolic reversal in the hepatic vein ( Figure 4A through 4D). There was no evidence of left ventricular dysfunction.The clue to the underlying pathogenesis of her complicated clinical picture was obtained from a dietary history, which evolved during her hospital stay. The patient refused to drink water from the hospital because she believed it to be contaminated. She rejected hospital food because she only ate organic food at home. Her diet at home was strictly limited to cereal, eggs, and milk. Vitamin deficiency was suspected, and vitamin C level was found to be 0.1 mg/dL (normal ...

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Scurvy: A cutaneous clinical diagnosis

Cited by 36 publications

References 18 publications

Scurvy in a Patient with Depression

Scurvy in a Patient with Depression

A historic disease still prevalent today

Reversible Right Heart Failure in Scurvy Rediscovery of an Old Observation

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