Mazza Tina, David Antoine, Kaya Gürkan, Menzinger Sébastien, Berner Amandine, Serratrice Jacques, Coen Matteo
Division of General Internal Medicine, Department of Medicine, University Hospitals, Genève, Switzerland.
Department of Dermatology and Venereology, University Hospital of Geneva, Genève, Switzerland.
Medicine (Baltimore). 2025 Sep 5;104(36):e44120. doi: 10.1097/MD.0000000000044120.
This case highlights the importance of considering a wide range of possible diagnoses when faced with unexplained hemorrhagic symptoms. When standard investigations fail to identify a clear cause, it is essential to conduct a detailed dietary history. This can lead to the diagnosis of scurvy, a reversible vitamin C deficiency that is often overlooked in populations at risk.
The patient is a 55-year-old man with well-controlled Crohn disease who presented with unexplained bilateral leg pain and extensive hematomas on his lower limbs, significantly affecting his mobility and raising concerns about a serious condition.
The final diagnosis was scurvy, resulting from a chronic deficiency of vitamin C due to a severely limited diet that lacked fruits and vegetables. Initially, differential diagnoses included deep vein thrombosis and drug-induced coagulopathy. However, a physical examination revealed follicular purpura, and the identified dietary restrictions ultimately led us to the correct diagnosis and enabled effective treatment.
Vitamin C supplementation was initiated.
Timely identification and vitamin C supplementation resulted in a rapid improvement in the patient's condition.
This case highlights the importance of recognizing nutritional deficiencies in modern medicine, especially for patients with chronic illnesses. It demonstrates that classic diseases, such as scurvy, can still occur and be overlooked if comprehensive patient histories and thorough examinations are not conducted.
该病例凸显了面对不明原因的出血症状时考虑多种可能诊断的重要性。当标准检查未能明确病因时，详细询问饮食史至关重要。这可能会诊断出坏血病，一种可逆的维生素C缺乏症，在高危人群中常被忽视。
患者为一名55岁男性，克罗恩病病情控制良好，出现不明原因的双侧腿痛及双下肢广泛血肿，严重影响其活动能力，引发对严重疾病的担忧。
最终诊断为坏血病，病因是饮食严重受限，缺乏水果和蔬菜，导致慢性维生素C缺乏。最初，鉴别诊断包括深静脉血栓形成和药物性凝血病。然而，体格检查发现毛囊性紫癜，确定的饮食限制最终使我们得出正确诊断并实现有效治疗。
开始补充维生素C。
及时识别并补充维生素C使患者病情迅速改善。
该病例凸显了现代医学中认识营养缺乏症的重要性，尤其是对于慢性病患者。它表明，如果不进行全面的患者病史询问和彻底检查，坏血病等经典疾病仍可能发生并被忽视。
