End stage scurvy in the developed world: A diagnostic conundrum but not to be mistaken for pyoderma gangrenosum

Int Wound J. 2019 Aug;16(4):1024-1028. doi: 10.1111/iwj.13149. Epub 2019 Jun 2.

Abstract

Scurvy is a clinical syndrome, resulting from ascorbic acid deficiency. Prevalence of the condition is now extremely low in the Western population and its diagnosis can be challenging without a high index of suspicion. When cases do present, they are often misdiagnosed initially. Therefore, a thorough history, physical exam, and laboratory evaluation are key to showing this now rare but extremely well-known disease. We report a case of scurvy manifesting as persistent non-healing lower-extremity ulcerations, initially mistaken for pyoderma gangrenosum. The patient responded to appropriate replacement therapy, but ulcers were slow to heal. As was the case in our patient, symptom reversal may require additional nutritional replacement. We encourage physicians to consider nutritional deficiencies in their differential diagnoses and highlight the incidence of malnutrition in the proper clinical setting to avoid diagnostic delay.

Keywords: ascorbic acid; pyoderma gangrenosum; scurvy; ulcers; wound healing.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Delayed Diagnosis
  • Dermatologic Agents / therapeutic use*
  • Diagnosis, Differential
  • Female
  • Humans
  • Immunotherapy / methods*
  • Infliximab / therapeutic use*
  • Leg Ulcer / diagnosis*
  • Leg Ulcer / therapy
  • Pyoderma Gangrenosum / diagnosis*
  • Pyoderma Gangrenosum / epidemiology
  • Pyoderma Gangrenosum / therapy*
  • Scurvy / diagnosis*
  • Scurvy / therapy*
  • Treatment Outcome
  • Western World

Substances

  • Dermatologic Agents
  • Infliximab