SHM Converge Scientific Abstract ePoster Gallery-Un-Peeling the Mystery: The Tale of the Stubborn Sore

Pdf Summary

This case describes a 63-year-old woman with a chronic, nonhealing sacral wound that had persisted for more than three years despite treatment. Her history was notable for pelvic rhabdomyosarcoma treated with high-dose radiation, followed by severe gastrointestinal complications including pancolitis, enteric strictures, small bowel obstruction, and ultimately small bowel resection with end ileostomy. She also presented with severe hypomagnesemia.<br /><br />Her symptoms included hair loss, palmar and periauricular desquamation, periodontal ecchymoses, perifollicular petechiae, fatigue, arthralgias, and a purulent sacral wound. Workup revealed multiple nutritional deficiencies, including vitamin B6, zinc, iron, magnesium, and markedly low vitamin C (6 umol/L), leading to the diagnosis of scurvy.<br /><br />The case highlights that scurvy can present with nonspecific systemic symptoms as well as classic skin and gingival findings. In patients with malnutrition, malabsorption, or complex surgical histories, vitamin C deficiency should be considered as a contributor to chronic wounds and impaired healing. Diagnosis is primarily clinical, supported by low serum or leukocyte vitamin C levels. Treatment with vitamin C supplementation, either oral or intravenous depending on severity and absorption issues, usually leads to rapid improvement.<br /><br />In this patient, antibiotics did not resolve the wound. She initially improved with IV vitamin C, failed oral supplementation, and then improved again after resuming IV infusions, with significant wound healing and symptom resolution. The report emphasizes the importance of recognizing nutritional deficiencies early, especially in patients with malabsorption, because timely replacement can dramatically improve outcomes.

Asset Subtitle

John Romond

Meta Tag

Author List John Romond, Sadie Junkins

Category Clinical Vignettes

Concept Vitamin C Deficiency

Concept Collagen Synthesis

Concept Wound Healing

Concept Gingival Bleeding

Concept Petechiae

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author John Romond

Track Adult

Keywords

scurvy

vitamin C deficiency

chronic wound

malabsorption

malnutrition

sacral wound

hypomagnesemia

nutritional deficiencies

wound healing

oral and intravenous vitamin C

Vitamin C Deficiency

Collagen Synthesis

Wound Healing

Gingival Bleeding

Petechiae