SHM Converge Scientific Abstract ePoster Gallery-Vitamin C Deficiency (Scurvy) in a Hemodialysis Patient

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This case describes a 35-year-old woman with congenital renal dysplasia and end-stage renal disease on hemodialysis who presented with worsening fatigue, dyspnea on exertion, and a new pruritic rash on her legs. She had a history of malnutrition and multiple vitamin deficiencies, including folate, B12, and A. On exam, she had classic signs of scurvy: perifollicular erythema, petechiae, corkscrew hairs, and mild gingival erythema. Her hemoglobin fell sharply from 9 to 5 g/dL, and her vitamin C level was undetectable. Endoscopy did not show malabsorption.<br /><br />She was diagnosed with vitamin C deficiency (scurvy), which was felt to explain her rash, constitutional symptoms, and worsening anemia. The report emphasizes that scurvy is based on clinical findings, dietary history, and response to vitamin C supplementation. Although uncommon in developed countries, it is often overlooked because symptoms such as rash, anemia, weakness, and fatigue overlap with those of ESRD.<br /><br />Patients at higher risk include those with malnutrition, advanced age, psychiatric illness, substance use, cancer, unstable housing, malabsorption, and especially individuals on hemodialysis. In dialysis patients, vitamin C deficiency can occur because vitamin C is removed during dialysis, dietary intake may be restricted due to potassium concerns, and appetite may be reduced by chronic illness.<br /><br />The key conclusion is that scurvy should be considered in hemodialysis patients with unexplained rash, anemia, and fatigue, since prompt recognition and vitamin C replacement can reverse symptoms.

Asset Subtitle

Alexandra M. Glaeser

Meta Tag

Author List Alexandra M. Glaeser, Felicia Hsu, Sophie Carlson, Wendi LeBrett

Category Clinical Vignettes

Concept Vitamin C Deficiency

Concept Hemodialysis

Concept Rash

Concept Petechiae

Concept Corkscrew Hair

Distinguished Non-Finalist

Presenter Organization Univeristy of California Los Angeles, Department of Medicine

Presenting Author Alexandra M. Glaeser

Track Adult

Keywords

scurvy

vitamin C deficiency

hemodialysis

end-stage renal disease

anemia

pruritic rash

corkscrew hairs

perifollicular erythema

malnutrition

vitamin supplementation

Vitamin C Deficiency

Hemodialysis

Rash

Petechiae

Corkscrew Hair