SHM Converge Scientific Abstract ePoster Gallery-Scurvy: A Missed Mimicker of Vasculitis

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This case describes a 62-year-old woman with hepatitis C history, cirrhosis, chronic pancytopenia, hypothyroidism, smoking, and prior cocaine use who presented with one month of progressive bilateral leg weakness and severe pain. She had tachycardia, a purpuric/petechial rash on the thigh, a painful knee effusion, and abdominal tenderness. Her workup strongly suggested vasculitis because of arthralgias, rash, pancytopenia, elevated inflammatory markers, and strikingly positive vasculitis serologies including MPO antibody, PR-3 antibody, and high-titer p-ANCA. As a result, multiple specialties were consulted and extensive testing was pursued for vasculitis, malignancy, and SLE.<br /><br />However, the true diagnosis was scurvy. Vitamin C levels were undetectable/very low, and a dietary history eventually revealed that she ate mainly Cheetos. Her presentation was consistent with vitamin C deficiency, which impairs collagen synthesis and can cause poor wound healing, petechiae, perifollicular hemorrhage, hemarthrosis, ecchymoses, and myalgias—features that can closely mimic vasculitis. In this case, cirrhosis and abnormal labs further distracted from the diagnosis. Some findings, such as a rash biopsy showing only a bruise and large ecchymosis after paracentesis, also fit a bleeding tendency from scurvy.<br /><br />She was treated with oral vitamin C 500 mg daily for one month, followed by a multivitamin. The authors emphasize that scurvy should remain on the differential for patients with purpura, arthralgias, and bleeding symptoms, even in developed countries. A careful dietary history early in the evaluation could have shortened hospitalization, reduced unnecessary testing, and improved patient care.

Asset Subtitle

Ghazal Aghagoli

Meta Tag

Author List Anurag R. Goel, Ghazal Aghagoli, Kyla A. Dewar, Owen D. Maguire, Peter G. Brodeur

Category Clinical Vignettes

Concept Scurvy

Concept Ascorbic Acid

Concept Vasculitis

Concept Petechiae

Concept Purpura

Distinguished Non-Finalist

Presenter Organization Alpert Medical School of Brown University

Presenting Author Ghazal Aghagoli

Track Adult

Keywords

scurvy

vitamin C deficiency

vasculitis mimic

purpura

petechiae

arthralgia

cirrhosis

pancytopenia

collagen synthesis

dietary history

Scurvy

Ascorbic Acid

Vasculitis

Petechiae

Purpura