Na In Sun, Nguyen Kevin, Potenzi Bradley, Cheah Minz
Department of Rehabilitation Medicine, Alfred Health, Melbourne, Victoria, Australia
Department of General Medicine, Monash Health, Clayton, Victoria, Australia.
BMJ Case Rep. 2020 Mar 4;13(3):e233645. doi: 10.1136/bcr-2019-233645.
A 66-year-old Caucasian woman was admitted with deteriorating mental health in the setting of background history of schizophrenia and depression. Her husband reported that she had increasing negative thoughts and decreased motivation regarding her self-care over a few weeks with no obvious stressors. Initial laboratory tests were unremarkable except for isolated normocytic anaemia. Physical examination revealed widespread bilateral upper limb ecchymoses and lower limb petechial rash. After an extensive investigation with no definitive results to explain her clinical presentations, diagnosis of scurvy was suspected and confirmed with severely low serum vitamin C level. Her clinical symptoms improved markedly with oral supplementation, which further supported the diagnosis of scurvy. Although it is now a rare condition in developed countries, this case will remind modern medical practitioners that patients with scurvy may present with non-specific symptoms and clinical findings such as depression and anaemia.
一名66岁的白人女性因精神健康状况恶化入院,她有精神分裂症和抑郁症病史。她的丈夫报告说,在没有明显压力源的情况下,她在几周内出现了越来越多的消极想法,自我照顾的动力也有所下降。除了单纯的正细胞性贫血外,最初的实验室检查无异常。体格检查发现双侧上肢广泛瘀斑和下肢瘀点性皮疹。经过广泛检查,没有明确结果可以解释她的临床表现,怀疑为坏血病,并通过血清维生素C水平严重降低得到证实。口服补充维生素C后,她的临床症状明显改善,这进一步支持了坏血病的诊断。尽管在发达国家这现在是一种罕见的疾病,但这个病例将提醒现代医学从业者,坏血病患者可能会出现非特异性症状和临床体征,如抑郁和贫血。