SHM Converge Scientific Abstract ePoster Gallery-Obesity and Malnutrition: What Are We Missing? A Case of Scurvy in a 500 Pound Patient.

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This case report highlights an underrecognized form of malnutrition: micronutrient deficiency in patients with obesity. A 64-year-old man with severe obesity (BMI 70), hypertension, and recent COVID-19 infection presented with fever, anorexia, flank pain, and two months of progressive oral sores. He was found to have bilateral pyelonephritis, mild anemia, leukocytosis, extensive gingival swelling and bleeding, oral ulcers, ecchymoses, and later perifollicular hemorrhages. His mouth lesions were initially treated as oral candidiasis, but antifungal therapy failed.<br /><br />Further history revealed a 20.4 kg (45 lb) unintentional weight loss over six weeks and a diet lacking fresh fruits and vegetables, relying mainly on convenience-store food. Nutritional testing showed a profoundly low vitamin C level (0.1 mg/dL), confirming scurvy. Additional deficiencies included vitamin A, vitamin B6, folate, and vitamin B12. Dermatology agreed that his skin and oral findings were consistent with untreated scurvy.<br /><br />Before high-dose vitamin C could be started, the patient aspirated and developed acute hypoxemic respiratory failure requiring intubation. His condition worsened, and the family chose comfort-focused care. He died on hospital day seven.<br /><br />The discussion emphasizes that scurvy, once considered rare in developed countries, is increasingly reported in people with obesity. Obesity is associated with lower vitamin C stores, likely due to poor diet, increased metabolic demand, and oxidative stress. Acute illnesses can rapidly deplete already limited reserves. The case also illustrates how implicit bias may delay recognition of malnutrition in patients who appear “well-fed.” The authors conclude that patients with obesity, especially those who are critically ill, are often not adequately screened for micronutrient deficiencies, leading to delayed diagnosis and worse outcomes.

Asset Subtitle

Kelsey Lynch

Meta Tag

Author List Kelsey Lynch

Category Clinical Vignettes

Concept Obesity

Concept Malnutrition

Concept Micronutrient Deficiency

Concept Vitamin C Deficiency

Concept Dietary History

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Kelsey Lynch

Track Adult

Keywords

obesity

scurvy

vitamin C deficiency

micronutrient deficiency

malnutrition

oral ulcers

gingival bleeding

perifollicular hemorrhage

micronutrient screening

dietary deficiency

Obesity

Malnutrition

Micronutrient Deficiency

Vitamin C Deficiency

Dietary History