title: [Atypical scurvy associated with anorexia nervosa].
abstract: BACKGROUND
  Scurvy, or "Barlow's disease", is a widely described disease involving cutaneous and mucosal lesions resulting from vitamin C deficiency. Herein, we report a case of scurvy in a 48-year-old woman that was unusual in its atypical cutaneous-mucosal presentation as well as its association with anorexia nervosa.
  
  
  METHODS
  A 48-year-old woman treated for depression for several years was admitted to hospital for her impaired general state of health. Over the last year, she had presented palmoplantar rash and episodes of perimalleolar oedema. The clinical examination showed the patient to have wasting syndrome, with a BMI of 11.9kg/m2, lower-limb oedema, palmoplantar fissures, geographic tongue, telogen effluvium and purpuric petechiae on her right knee. However, no gingival bleeding was noted and there was no loss of tooth enamel. The remainder of the clinical examination was normal. Blood tests revealed extremely low vitamin C levels without any other associated deficiencies, as well as laboratory signs of cytolysis and anicteric cholestasis without inflammatory syndrome. The diagnosis of anorexia nervosa was made by psychiatrists, despite the unusual age of onset. Favorable clinical outcome was rapidly achieved via a one-month course of vitamin C supplements at a daily dose of 1g.
  
  
  CONCLUSIONS
  The absence of classical buccal-dental symptoms and the presence of keratotic dermatosis with fissures and ulcers on the hands and feet are atypical in scurvy; however, this diagnosis was confirmed by the existence of purpura evoking capillary fragility, the patient's drastically low vitamin C level and the rapid subsidence of symptoms following treatment with oral vitamin C alone. Anorexia nervosa was doubtless the cause of deficiency. This situation is rare and a systematic review of the literature in Medline via PubMed showed that only three reports of scurvy associated with mental anorexia have been published since 1975.
authors: Service de médecine interne générale, hôpitaux universitaires de Genève, 1206 Genève, Suisse. Electronic address: randre2@bluewin.ch.
authors: R
authors: R
authors: André
authors: Service de médecine interne générale, hôpitaux universitaires de Genève, 1206 Genève, Suisse.
authors: A
authors: A
authors: Gabrielli
authors: Service de dermatologie et vénéréologie, hôpitaux universitaires de Genève, 1206 Genève, Suisse.
authors: E
authors: E
authors: Laffitte
authors: Service de médecine interne générale, hôpitaux universitaires de Genève, 1206 Genève, Suisse; Service de médecine interne, hôpital de la Tour, 1217 Meyrin-Genève, Suisse.
authors: O
authors: O
authors: Kherad
mesh_terms: D000856:Anorexia Nervosa / Q000097:blood / Q000175:diagnosis*; D001205:Ascorbic Acid / Q000097:blood / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012614:Scurvy / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D019282:Wasting Syndrome / Q000097:blood / Q000175:diagnosis
chemical_list: D001205:Ascorbic Acid
keywords: Acide ascorbique; Anorexia; Anorexie mentale; Ascorbic acid; Barlow's disease; Maladie de Barlow; Scorbut; Scurvy; Vitamin C; Vitamine C