SHM Converge Scientific Abstract ePoster Gallery-A Scurrilous Case of Bruising

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This case describes a 56-year-old woman with Parkinson’s disease and seizures who presented with one month of dyspnea, easy bruising, weight loss, fatigue, and constipation. She had bilateral petechiae and a large hematoma of the right lower extremity, but no history of trauma and no use of anticoagulants or antiplatelet drugs. Her diet was extremely limited, consisting mainly of bread, cheese, and bacon, and she had a long history of tobacco and heavy alcohol use.<br /><br />Initial evaluation showed anemia (Hgb 7.7) with otherwise unremarkable platelets, renal function, and imaging. CT angiography revealed multiple soft tissue hematomas in the right leg without active bleeding, and venous Dopplers were negative for DVT. Further workup identified multiple vitamin deficiencies, including a markedly low vitamin C level of 0.1 mg/dL, confirming scurvy.<br /><br />The presentation highlights that scurvy remains an important but often overlooked diagnosis, even in resource-rich settings. It should be considered in patients at risk, including those with poor nutrition, alcohol or tobacco use, cognitive impairment, low socioeconomic status, malabsorption, or dialysis dependence. Symptoms typically appear after 1–3 months of inadequate vitamin C intake and reflect impaired collagen synthesis, leading to capillary fragility, bruising, gingival bleeding, fatigue, dyspnea, and anemia.<br /><br />The patient was treated with multivitamin, iron, folate, and vitamin C supplementation, and discharged with dietary counseling. After establishing primary care and improving her diet, her symptoms improved. The case emphasizes the importance of obtaining a detailed dietary history when evaluating unexplained bruising and anemia, as scurvy is readily treatable and prognosis is excellent with vitamin replacement and nutritional improvement.

Asset Subtitle

Alexandra B. Khodadadi

Meta Tag

Author List Alexandra B. Khodadadi, Mohit Harsh, Natalia Morales

Category Clinical Vignettes

Concept Scurvy

Concept Vitamin C Deficiency

Concept Collagen Synthesis

Concept Vitamin C Supplementation

Concept Easy bruising

Distinguished Non-Finalist

Presenter Organization Barnes Jewish Hospital/ Washington University School of Medicine Internal Medicine Residency

Presenting Author Alexandra B. Khodadadi

Track Adult

Keywords

scurvy

vitamin C deficiency

easy bruising

anemia

poor nutrition

hematoma

Parkinson’s disease

dietary history

capillary fragility

vitamin supplementation

Scurvy

Vitamin C Deficiency

Collagen Synthesis

Vitamin C Supplementation

Easy bruising