Esteves Alexandra, Teixeira da Silva Francisco, Carvalho José, Felgueiras Paula, Laranjeira Paulo
Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT.
Department of Safety, Health and Environment, School of Management and Technology, Polytechnic Institute of Porto, Porto, PRT.
Cureus. 2021 Feb 5;13(2):e13158. doi: 10.7759/cureus.13158.
Scurvy is a disease caused by vitamin C deficiency, historically associated with long sea voyages, periods of famine and war. Currently, it is often misdiagnosed and underreported, as physicians tend to consider it a disease of the past. We present the case of a 79-year-old female who was admitted to the Emergency Department complaining of pruritus. The patient lived alone and in poor hygiene conditions. Diet was scarce. One week before admission she was in contact with flea-ridden stray dogs. Sometime later she noted several fleas and multiple pruritic small papules, crusts, and excoriations on her torso, limbs, palms, soles, and scalp. Physical examination showed the patient to be pale, emaciated, and poorly groomed. Laboratory analysis showed microcytic anemia. Flea bites were treated with oral antihistamines and prednisolone. Follow-up one month later showed weight gain and partial resolution of skin lesions. However, multiple small ecchymosis on both lower and upper limbs, and occasional perifollicular petechias on her lower extremities, were noted. Additional workup showed undetectable serum vitamin C levels. A diagnosis of scurvy was made. The patient was treated with 1000 mg per day of oral vitamin C for one month leading to complete recovery. We present this case to remind that early recognition of vitamin C deficiency and appropriate supplementation are essential in patients with scurvy. Physicians should be aware of classic signs, symptoms, and social factors associated with this forgotten disease.
坏血病是一种由维生素C缺乏引起的疾病，在历史上与长期海上航行、饥荒时期和战争有关。目前，它常常被误诊且报告不足，因为医生往往认为这是一种过去的疾病。我们报告一例79岁女性患者，因瘙痒而入住急诊科。该患者独居，卫生条件差。饮食匮乏。入院前一周，她接触了有跳蚤的流浪狗。一段时间后，她注意到躯干、四肢、手掌、脚底和头皮上有几只跳蚤以及多个瘙痒的小丘疹、结痂和擦伤。体格检查显示患者面色苍白、消瘦且不修边幅。实验室分析显示小细胞性贫血。跳蚤叮咬用口服抗组胺药和泼尼松龙治疗。一个月后的随访显示体重增加，皮肤病变部分消退。然而，注意到双下肢和上肢有多处小瘀斑，下肢偶尔有毛囊周围瘀点。进一步检查显示血清维生素C水平检测不到。诊断为坏血病。患者接受每天1000毫克口服维生素C治疗一个月，最终完全康复。我们报告这个病例是为了提醒，对于坏血病患者，早期识别维生素C缺乏并进行适当补充至关重要。医生应该了解与这种被遗忘疾病相关的典型体征、症状和社会因素。
