title: A Case of Scurvy-Uncommon Disease-Presenting as Panniculitis, Purpura, and Oligoarthritis.
abstract: OBJECTIVE
  Scurvy remains prevalent in certain populations, including addicts, people of low socioeconomic status, and the severely malnourished. It classically presents as follicular hyperkeratosis and perifollicular hemorrhage of the lower extremities, as well as bleeding in other areas such as the gingiva and joints. This case presentation and literature review highlights the common pathophysiological findings associated with scurvy and current methods of diagnosis and treatment.
  
  
  METHODS
  The patient described in this case presented with sudden oligoarthritis and purpura of the lower extremities. Following progression of the patient's symptoms and a low vitamin C serum concentration, the patient was treated with vitamin C supplementation and dramatically improved. This was considered to be the result of an underlying vitamin C deficiency secondary to insufficient fruit and vegetable intake due to allergies.
  
  
  CONCLUSIONS
  This case highlights the importance of maintaining a high index of suspicion for scurvy in atypical presentations of purpura not better explained by another disease or in additional populations at high risk of vitamin C deficiency. Early diagnosis by either a primary care physician or dermatologist can expedite the treatment process and improve patient prognosis.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mintsoulis
authors.affiliation: Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Milman
authors.affiliation: Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada sfahim@toh.ca.
authors.forename: Simone
authors.initials: S
authors.lastname: Fahim
mesh_terms: D000368:Aged; D001168:Arthritis / Q000209:etiology; D001205:Ascorbic Acid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015434:Panniculitis / Q000209:etiology; D011693:Purpura / Q000209:etiology; D012614:Scurvy / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D001205:Ascorbic Acid
keywords: oligoarthritis; panniculitis; purpura; scurvy; vitamin C