Department of Family Practice, University of Alabama, Huntsville, AL, USA.
J Gen Intern Med. 2008 Aug;23(8):1281-4. doi: 10.1007/s11606-008-0577-1. Epub 2008 May 6.
Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.
We report the case of a 57-year-old male who presented with a combined vitamin C deficiency (scurvy) and a Zinc deficiency.
He came to the emergency department complaining of a painful swollen ecchymotic leg and dyspnea. Prescriptions for narcotics did not relieve his symptoms. When a detailed dietary history was obtained, we added scurvy to the differential diagnosis. An extensive evaluation excluded trauma, coagulopathies, neoplasia, and vasculitides.
The combination of a classic skin biopsy and a low vitamin C level confirmed the diagnosis.
This presentation illustrates the necessity of including scurvy in the differential diagnosis of ecchymoses and demonstrates specific populations at risk: single adults and the elderly with deficient diets.
尽管维生素和强化食品广泛供应,但坏血病在发达国家仍不常见,但仍有发生。1994 年全国健康和营养检查调查(NHANES)报告称,成年人中维生素 C 缺乏的患病率为 10%至 14%。
我们报告了一例 57 岁男性患者,其同时患有维生素 C 缺乏症(坏血病)和锌缺乏症。
他因疼痛性肿胀瘀斑的腿部和呼吸困难来到急诊部。开了麻醉止痛药,但未能缓解他的症状。当详细询问饮食史时,我们将坏血病纳入鉴别诊断。广泛的评估排除了创伤、凝血障碍、肿瘤和血管炎。
典型的皮肤活检和低维生素 C 水平证实了这一诊断。
这种表现说明了将坏血病纳入瘀斑鉴别诊断的必要性,并指出了特定的高危人群:单身成年人和饮食不良的老年人。