Vitamin C or not to see: A diagnostic dilemma

Scurvy is a severe deficiency of vitamin C, or ascorbic acid. Despite it’s perceived rarity in developed countries, certainpopulations are at higher risk of developing scurvy, and a delay in diagnosis can lead to significant morbidity and possibly death. In this case, a 46-year-old female was admitted to the hospital with subtle mood changes, memory loss, and generalized failureto thrive. Physical exam revealed a petechial rash. Evaluation and workup by multiple physicians revealed no source for hercondition, which continued to deteriorate. Finally, because of the patient’s rash, a nutritional history was taken which was highlyconcerning for scurvy. An ascorbic acid level was ordered and returned at 0 mg/dl (reference range 0.2-2 mg/dl), confirming theclinical diagnosis of scurvy. Ascorbic acid repletion reversed her symptoms and she was discharged home uneventfully. Ascorbicacid is vital for the integrity of skin and soft tissues. Due to its high prevalence in the diets of most developed countries, scurvyhas become a rare diagnosis that many providers do not recognize. Despite its rarity, certain populations are still at risk andproviders should remain cognizant of the diagnosis, especially when classic manifestations such as a petechial rash or bleedinggums are seen.