SHM Converge Scientific Abstract ePoster Gallery-An Orange a Day to Keep the Bleeding Away

Pdf Summary

This case describes a 29-year-old woman admitted for severe anemia, bleeding, bruising, and thrombosis. She had a history of two first-trimester pregnancy losses, a spontaneous calf hematoma, and an unprovoked right popliteal deep vein thrombosis. On exam, she had gingival bleeding, diffuse petechiae and purpura, tender leg swelling, and hematoma. Labs showed marked anemia (hemoglobin 6.1 g/dL), leukopenia, elevated reticulocytes, low vitamin K, and mildly abnormal antiphospholipid testing. Imaging did not reveal a bleeding source.<br /><br />A detailed dietary history uncovered that she avoided fruits because of prior anaphylactic reactions and also avoided vegetables. She was diagnosed with scurvy based on classic findings: follicular hyperkeratosis, coiled hairs, dental caries, gingival bleeding, bruising, and anemia. Vitamin K deficiency was also considered the likely cause of her bleeding tendency. Because anticoagulation had failed and there was concern for ongoing thrombosis, an inferior vena cava filter was placed. She was started empirically on vitamin C 500 mg daily.<br /><br />At four-week follow-up, her petechiae, leukopenia, and anemia had resolved, supporting the diagnosis. The report emphasizes that scurvy, though rare in developed countries, should be considered in patients with poor intake of fruits and vegetables who present with petechiae, gingival bleeding, hematomas, and anemia. It also highlights the importance of evaluating for additional nutritional deficiencies. Finally, because acute unprovoked DVT is unusual in scurvy, the authors suggest possible underlying antiphospholipid syndrome and recommend repeat testing.

Asset Subtitle

Michael Osnard

Meta Tag

Author List Ashwini Niranjan-Azadi, Michael Osnard

Category Clinical Vignettes

Concept Scurvy

Concept Ascorbic Acid

Concept Vitamin C Supplementation

Concept Bleeding Manifestation

Concept Gingival Bleeding

Distinguished Non-Finalist

Presenter Organization The Johns Hopkins Hospital

Presenting Author Michael Osnard

Track Adult

Keywords

scurvy

vitamin C deficiency

anemia

gingival bleeding

petechiae

purpura

deep vein thrombosis

vitamin K deficiency

antiphospholipid syndrome

nutritional deficiency

Scurvy

Ascorbic Acid

Vitamin C Supplementation

Bleeding Manifestation

Gingival Bleeding