(Kiosk 2) Unmasking Scurvy in 2023: A Rheumatologic Mimic

Case Diagnosis: Two patients presenting with rash and arthralgia diagnosed with scurvy.

Case Description: We present two cases of scurvy diagnosed within a 3-month span who presented with arthralgia and rash. Neither patient had conditions that predispose vitamin C deficiency, highlighting the need for awareness of scurvy based on presenting symptoms.

Discussion: Scurvy, once a bane of pirates and sailors, is the result of vitamin C deficiency. Humans are unable to synthesize this vitamin critical for collagen synthesis and must rely on dietary sources. While often not considered in modern differential diagnoses, scurvy can present with symptoms such as petechial rash, polyarthralgia, and even sicca syndrome which may lead to rheumatologic evaluation.

Setting: Community of 850,000+ people.

Assessment/Results: A 62-year-old man was admitted to the hospital for anemia, knee pain, and rash. He had been eliminating irritating foods from his diet for over a year. A 30-lb weight loss was noted, and he was unable to bear weight due to severe knee pain. On exam he had a lower extremity rash, follicular hypertrophy, and corkscrew hairs. His knee was warm, thickened, and ecchymotic. Rheumatology was consulted and his vitamin C level was found to be undetectable. He was initiated on Vitamin C supplementation and his symptoms quickly improved.

A 35-year-old female with Sjogren’s Syndrome presented for outpatient rheumatologic care and was noted to have a 6-week history of bilateral lower extremity rash. Dietary history was notable for no fruit or multivitamin intake. On examination she had perifollicular rash and ecchymoses over her left knee. Her vitamin C level was undetectable, and she was started on supplementation. Her symptoms quickly improved but her sicca symptoms did not appreciably change.

Conclusion: These cases highlight the morbidity scurvy can offer patients and the need to include scurvy in the differential diagnosis for rash and arthralgia, even in patients without predisposing conditions.