title: From past sailors' eras to the present day: scurvy as a surprising manifestation of an uncommon gastrointestinal disease.
abstract: A 45-year-old man presented with follicular exanthema in his lower limbs, alternating bowel habits and significant weight loss. His medical history included seronegative arthritis, bipolar disease and an inconclusive diagnostic laparoscopy. Diagnostic work up revealed microcytic anaemia and multivitamin deficiency. Skin biopsy of the exanthema suggested scurvy. Owing to these signs of malabsorption, upper endoscopy with duodenal biopsies was performed, exhibiting villous atrophy and extensive periodic acid-Schiff-positive material in the lamina propria, therefore diagnosing Whipple's disease (WD). After starting treatment with ceftriaxone and co-trimoxazole, an impressive recovery was noted, as the wide spectrum of malabsorption signs quickly disappeared. After a year of antibiotics, articular and cutaneous manifestations improved, allowing the patient to stop taking corticosteroids and antidepressants. This truly unusual presentation reflects the multisystemic nature of WD, often leading to misdiagnosis of other entities. Scurvy is a rare finding in developed countries, but its presence should raise suspicion for small bowel disease.
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Diogo Ferreira
authors.initials: DF
authors.lastname: Branquinho
authors.affiliation: Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pinto-Gouveia
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Mendes
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sofia
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001706:Biopsy; D002443:Ceftriaxone / Q000008:administration & dosage; D003951:Diagnostic Errors; D005076:Exanthema / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012614:Scurvy / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D054851:Tropheryma / Q000302:isolation & purification; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination