Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico - Università Cattolica del Sacro Cuore, Roma, Italy.
Nutr Clin Pract. 2021 Oct;36(5):1063-1067. doi: 10.1002/ncp.10616. Epub 2020 Dec 23.
An 18-year-old man presented to our hospital with muscular pain, diffuse petechiae, spontaneous thigh ecchymosis, edema and pain of the right knee, bilateral pretibial subcutaneous nodules, and gingival hypertrophy and hemorrhage. His history was positive for a mixed anxiety-depressive disorder and a restrictive diet caused by self-diagnosed food allergies. Skin lesions appeared like hyperkeratotic papules with coiled hairs and perifollicular hemorrhages. A diagnosis of scurvy was made upon demonstration of low serum levels of ascorbic acid. An allergy evaluation found cross-reactivity between pollens and food, related to the presence of panallergens. Moreover, we found that our patient was also affected by celiac disease. In conclusion, scurvy should be considered in the differential diagnosis of patients with petechiae and ecchymosis, especially when food restriction, malabsorption, or psychiatric disorders are present.
一位 18 岁男性因肌肉疼痛、全身瘀点、自发性大腿瘀斑、右膝关节肿胀疼痛、双侧胫骨前皮下结节以及牙龈肥大和出血就诊于我院。他有混合性焦虑抑郁障碍病史,且因自我诊断的食物过敏而进行限制饮食。皮肤损伤表现为角化过度的丘疹,伴有卷曲毛发和毛囊周围出血。由于血清抗坏血酸水平降低,诊断为坏血病。过敏评估发现花粉和食物之间存在交叉反应,与泛过敏原有关。此外,我们发现该患者还患有乳糜泻。总之,坏血病应作为瘀点和瘀斑患者的鉴别诊断之一,尤其是存在饮食限制、吸收不良或精神疾病时。