Scurvy Presenting as Weakness, Arthralgia, Myalgia, and Rash

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For 2 months, a 68-year-old man had had progressive weakness, arthralgia, myalgia, and a rash on the arms and legs (A). Closer examination of the rash showed petechial lesions and follicular hyperkeratosis with perifollicular hemorrhage and corkscrew hairs. The patient also had poor dentition and swollen, purple, spongy gingivae.

Notable laboratory findings included mild normocytic anemia and low levels of folate and albumin. The platelet count, prothrombin time/partial thromboplastin time, and results of screening for hepatitis and vasculitis, with erythrocyte sedimentation rate, C-reactive protein, antimyeloperoxidase antibody, antiproteinase antibodies, c-anti-neutrophilic cytoplasmic antibodies (c-ANCA), p-ANCA, atypical ANCA, cryoglobulin, and rheumatoid factors, were all normal. Arterial and venous Doppler ultrasonograms of the lower extremities were also normal. The plasma ascorbic acid level was undetectable.

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Further questioning revealed that the patient's main diet consisted of potatoes, because he lived alone and did not know how to cook. Scurvy secondary to malnutrition was diagnosed.

The lesions on both the arms and legs almost completely resolved after 8 days of treatment with oral vitamin C (B). Scurvy, although unusual in developed countries, should be considered in the differential diagnosis of nonpalpable purpura. Early recognition is important because therapy for scurvy is specific and effective.