Mucocutaneous Manifestations of Scurvy- NEJM Clinical Review
A 72-year-old woman presented to the emergency department with a 3-month history of a rash on both legs and an additional 6 months of gingival bleeding. The patient’s medical history was notable for esophageal strictures leading to poor oral intake for at least 2 years. Physical examination of the legs showed perifollicular petechiae, follicular hyperkeratosis, and corkscrew hairs in addition to red and blue ecchymoses on both ankles. Examination of the oral mucosa showed gingival bleeding. A skin-biopsy sample obtained from a lesion on one leg showed a corkscrew hair with perifollicular hemorrhage.

Scurvy was suspected, and the diagnosis was subsequently confirmed by a measure of ascorbic acid in plasma of less than 5 µmol per liter (0.1 mg per deciliter; reference range, 23 to 114 µmol per liter [0.4 to 2.0 mg per deciliter]). Oral replacement of ascorbic acid was initiated at 500 mg daily for 3 months. The patient subsequently underwent serial esophageal dilations for management of the esophageal strictures and resumed a normal diet thereafter. At the 4-month follow-up, the skin and gingival findings had both resolved.

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