title: Scurvy is still present in developed countries.
abstract: BACKGROUND
  Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.
  
  
  OBJECTIVE
  We report the case of a 57-year-old male who presented with a combined vitamin C deficiency (scurvy) and a Zinc deficiency.
  
  
  METHODS
  He came to the emergency department complaining of a painful swollen ecchymotic leg and dyspnea. Prescriptions for narcotics did not relieve his symptoms. When a detailed dietary history was obtained, we added scurvy to the differential diagnosis. An extensive evaluation excluded trauma, coagulopathies, neoplasia, and vasculitides.
  
  
  RESULTS
  The combination of a classic skin biopsy and a low vitamin C level confirmed the diagnosis.
  
  
  CONCLUSIONS
  This presentation illustrates the necessity of including scurvy in the differential diagnosis of ecchymoses and demonstrates specific populations at risk: single adults and the elderly with deficient diets.
authors.affiliation: Department of Family Practice, University of Alabama, Huntsville, AL, USA.
authors.forename: Bertha
authors.initials: B
authors.lastname: Velandia
authors.forename: Robert M
authors.initials: RM
authors.lastname: Centor
authors.forename: Vicky
authors.initials: V
authors.lastname: McConnell
authors.forename: Mobin
authors.initials: M
authors.lastname: Shah
mesh_terms: D000407:Alabama; D001205:Ascorbic Acid / Q000627:therapeutic use*; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D012614:Scurvy / Q000175:diagnosis*; D015032:Zinc / Q000172:deficiency*
chemical_list: D015032:Zinc; D001205:Ascorbic Acid