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Scurvy presenting as lower limb ecchymoses in the setting of metastatic colorectal cancer
  1. Joshua M Inglis1,2 and
  2. Jia Tan3
  1. 1Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  3. 3Flinders Medical Centre, Bedford Park, South Australia, Australia
  1. Correspondence to Dr Joshua M Inglis; joshua.m.inglis{at}gmail.com

Abstract

A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have Klebsiella bacteraemia secondary to urinary source. Skin biopsy showed dermal haemorrhage without vessel inflammation. Vitamin C levels were low confirming the diagnosis of scurvy.

  • gastrointestinal surgery
  • chemotherapy
  • colon cancer
  • nutritional support
  • malnutrition

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Footnotes

  • Twitter @inglisjosh

  • Contributors JMI and JT contributed to the manuscript drafting and revision. Both authors approve the final manuscript for publication and were involved in managing the case.

  • 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.

  • Patient consent for publication Obtained.

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

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