SHM Converge Scientific Abstract ePoster Gallery-Arrgh You Sure It's Not Scurvy?: A Unique Presentation of Vitamin C Deficiency in a Post-Bypass Patient

Pdf Summary

This case report describes a 47-year-old woman with a history of Roux-en-Y gastric bypass, alcohol use disorder, opioid use disorder on methadone, seizures, and migraines who presented with 3 weeks of painful bilateral leg swelling and difficulty walking, along with 2 months of poor oral intake and persistent diarrhea. Exam showed brittle teeth, coarse hair, skin scaling, and marked bilateral lower extremity edema with erythema and severe tenderness.<br /><br />Initial evaluation ruled out several common causes of edema and leg pain. Doppler ultrasound was negative for deep vein thrombosis, chest imaging showed an unrelated left humeral head fracture/dislocation, and cardiac testing showed preserved ejection fraction without heart failure. Workup for lymphatic obstruction and protein-losing enteropathy was also unrevealing.<br /><br />Laboratory studies demonstrated macrocytic anemia, low calcium, elevated alkaline phosphatase, and evidence of multiple nutritional deficiencies. Most notably, vitamin C was undetectable, with additional deficiencies in vitamin A, vitamin D, and vitamin E. Her clinical findings and risk factors — prior gastric bypass, chronic alcohol use, poor intake, and prolonged diarrhea — supported severe vitamin C deficiency (scurvy) as the cause of her unusual presentation.<br /><br />The report highlights that although nutritional deficiencies are well recognized after gastric bypass surgery, vitamin C deficiency is less commonly reported. It emphasizes that scurvy can present not only with classic findings like skin changes, brittle hair, and gum abnormalities, but also with significant painful peripheral edema. Early recognition is important because gastric bypass patients with poor intake or intercurrent illness may be especially vulnerable to micronutrient deficiencies.

Asset Subtitle

Nooshin C. Beygui

Meta Tag

Author List Ahmun Zafar, Andrea Ramirez Cazares, Grace Macmillan, Kata Boros, Nooshin C. Beygui

Category Clinical Vignettes

Concept Vitamin C Deficiency

Concept Bilateral Lower Extremity Edema

Concept Micronutrient Deficiency

Concept Leg Pain

Concept Malnutrition

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai West/Morningside

Presenting Author Nooshin C. Beygui

Track Adult

Keywords

scurvy

vitamin C deficiency

Roux-en-Y gastric bypass

bilateral leg edema

painful swelling

nutritional deficiencies

macrocytic anemia

alcohol use disorder

diarrhea

micronutrient deficiency

Vitamin C Deficiency

Bilateral Lower Extremity Edema

Micronutrient Deficiency

Leg Pain

Malnutrition