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Disease of the past re-emerging in modern Australian society
  1. Mohammed Arif Uddin1,2,
  2. Christopher Robson1 and
  3. Ravindra Dotel1
  1. 1 Department of Infectious Diseases, Blacktown Hospital, Blacktown, New South Wales, Australia
  2. 2 Medical Workforce Unit, BMDH, Western Sydney Local Health District, Penrith, New South Wales, Australia
  1. Correspondence to Dr Mohammed Arif Uddin, arifuddin92{at}


A 28-year-old man with fever, atraumatic lower limb pain and rash was noted to have multiple areas of ecchymosis involving both lower limbs. He was anaemic and also had a grossly swollen left leg. Differential diagnoses of compartment syndrome, vascular tear, platelet and clotting factor disorders, vasculitis and myositis were ruled out. Scurvy was only considered after failing to reach a diagnosis. A dietary history revealed consumption of a restricted diet with no fresh fruits or vegetables. Diagnosis was supported by an undetectable vitamin C level in blood and a rapid improvement of symptoms on oral vitamin C replacement. Prevalence of vitamin C deficiency in developed countries is also discussed.

  • nutrition and metabolism
  • diet
  • public health

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  • Contributors MAU wrote up the initial draft of the report and made changes to the case report with input from the other authors. CR was significantly involved in reviewing the drafts and providing feedback into changes and improvements. He also provided some photographs from the case. RD came up with the idea to write up a report on this case and was involved heavily in revising the case report, providing patient images and giving final approval of the version to be submitted. He was also the physician to see the patient on follow-up. PR, while not an author, made the valuable contribution of the first coming up with the patient’s diagnosis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.