A woman repeatedly hospitalized for worsening symptoms was ultimately found to be suffering from a condition caused by a severe vitamin C deficiency due to her diet, doctors reported in a case study published in The Novel England Journal of Medicine. The case highlights the importance of considering nutritional deficiencies even when initial diagnoses are unclear.
The patient initially sought medical attention after experiencing acute pain, swelling, and bruising on her left knee following the use of an electric massage gun. She also disclosed a genetic mutation that increased her risk of blood clots, was taking anticoagulant medication, and had a history of heavy menstrual periods. Initial evaluations did not reveal an underlying cause, and she was advised to discontinue use of the massage gun.
Several weeks later, the patient returned to the emergency room with dizziness and shortness of breath. Doctors admitted her to the hospital, suspecting iron-deficiency anemia, and prescribed iron supplements and weekly intravenous infusions. However, her anemia and overall condition continued to decline despite treatment.
The young woman had stopped consuming citrus fruits years earlier, following an episode of hives that she attributed to their consumption. © Kittiphan, Adobe Stock
A third visit to the emergency room six weeks after her hospitalization brought new concerns: chest pain, night sweats, and a sudden weight loss of seven kilograms (approximately 15 pounds). She was also found to have a rapid heart rate and low blood oxygen levels, leading to immediate admission to the intensive care unit. Doctors diagnosed her with pulmonary hypertension, a severe form of high blood pressure affecting the arteries in the lungs and the right side of the heart.
Despite extensive testing, the cause of her hypertension remained elusive. Further examination revealed discolored spots and corkscrew-shaped hairs on her leg, along with soft, reddish-purple nodules along her gums. These skin symptoms ultimately led doctors to diagnose her with scurvy, a disease resulting from a severe deficiency in vitamin C.
The patient had eliminated citrus fruits from her diet years prior, believing she was allergic after experiencing hives. Blood tests confirmed the absence of vitamin C in her system, and supplementation was immediately initiated.
Just two days after starting vitamin C treatment, the patient was well enough to return home, with her health steadily improving over the following months.
Scurvy is a rare condition today, as adequate vitamin C intake through diet typically prevents its development. In this case, the diagnosis was complicated by the atypical presentation of pulmonary hypertension, which is not a common symptom of scurvy. More generally, the disease can be difficult to diagnose because initial symptoms are often non-specific and can mimic other conditions.
The authors of the report hope that sharing this case will remind physicians that scurvy, although uncommon, still exists and should be considered in the differential diagnosis when appropriate.
