Abstract

This case presents a male in his early 50s with bilateral painful petechial rash in the lower limbs, which occurred spontaneously without trauma. He also had macroscopic haematuria and macrocytic anaemia with mild neutropenia and lymphopenia. Vasculitis, autoimmune and haematological screens were negative. CT scan of his abdomen and lower limbs did not show any intra-abdominal bleeding or lower limb vasculitis. Skin biopsy was also unremarkable. His petechial rash continued to progress during admission. On further history, he revealed poor oral intake and cessation of his post-sleeve gastrectomy supplements, due to financial constraints. A nutritional panel showed undetectable vitamin C level, along with a few other nutritional deficiencies. He was treated for scurvy with vitamin C supplements, and his painful rash and haematuria resolved.

Scurvy is a re-emerging disease with the rising cost of living. It can present as early as a month after a vitamin C-deficient diet. The petechial skin lesions often occur especially in the lower extremities and may be mistaken for systemic vasculitis. The diagnosis is often made after an extensive diagnostic workup including imaging and biopsies, thus delaying treatment. Risk factors for scurvy include poor nutrition, gastric bypass surgeries, dialysis, alcoholism, psychiatric history and eating disorders. This disease is easily reversible with supplementation, with dramatic response seen within 24 hours. Failure to treat could lead to catastrophic haemorrhage. Hence, early recognition and prompt treatment are vital.