Blue velvet - Pseudocyanosis, a rare case of drug-induced bluish hyperpigmentation with clozapine: A case report.

RATIONALE

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.

PATIENT CONCERNS

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.

DIAGNOSES

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.

INTERVENTIONS

Vitamin C supplementation was initiated.

OUTCOMES

Timely identification and vitamin C supplementation resulted in a rapid improvement in the patient's condition.

LESSONS

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.