Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
BMJ Case Rep. 2022 Mar 7;15(3):e244594. doi: 10.1136/bcr-2021-244594.
A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and upper and lower extremity ecchymoses that had been present for 3 weeks. His initial laboratory results showed a normocytic anaemia, normal platelet count, slightly abnormal coagulation studies and normal inflammatory markers. Arthrocentesis of the left knee revealed haemarthrosis, and additional laboratory workup found an undetectable serum vitamin C (ascorbic acid) level consistent with scurvy. It was determined that scurvy had predisposed the patient to injury, leading to haemarthrosis. Following vitamin C supplementation, dietary and activity modifications, and acetaminophen as needed, the patient's serum vitamin C level normalised and his left knee pain and swelling improved. Scurvy is a rare cause of haemarthrosis, but it should be recognised in at-risk patients since treatment is effective.
一位 60 多岁的男性，有先前局部晚期头颈部癌症治疗史，因无创伤性左膝疼痛和上、下肢瘀斑就诊于急诊科，这些瘀斑已经存在 3 周了。他的初始实验室结果显示正细胞性贫血、血小板计数正常、凝血研究略有异常和正常炎症标志物。左膝关节穿刺术显示关节积血，进一步的实验室检查发现血清维生素 C（抗坏血酸）水平无法检测，符合坏血病。确定坏血病使患者容易受伤，导致关节积血。补充维生素 C、饮食和活动调整以及按需使用对乙酰氨基酚后，患者的血清维生素 C 水平正常化，左膝疼痛和肿胀改善。坏血病是关节积血的罕见原因，但应在有风险的患者中识别，因为治疗有效。
