Background: Scurvy is the clinical manifestation of vitamin C deficiency. It is historically linked to the era of large shipping expeditions. Today, it affects the patients with malnutrition. Its clinical presentations are multiple and sometimes misleading.

Aims: To present an unusual hemorrhage aetiology.

Methods: A new case report is reported.

Results: A 69-year-old patient, followed for primary cutaneous vasculitis treated with long-term corticosteroid therapy, was hospitalized for febrile impairment of the general condition.
Clinical examination showed a fever with extracellular dehydration, a BMI at 18 kg / m ² , alopecia and edentulousness. The patient had diffuse bruising of different age and skin vasculitis. The abdomen was tender but there was no rectal hemorrhage.
In biology, the patient had hyponatremia without dyskaliemia, a hypocholesterolemia, a hypocalcemia and an inflammatory biological syndrome. The hemoglobin was at 11 g/dl, there was a lymphopenia and a thrombocytopenia at 119000 el/ mm³. The AAN, the anti- ENA, ANCA and the antiphospholipid antibodies were negative. The myelogram was normal.
Initially, infectious endocarditis was evocated due to the presence of vegetation on the small mitral valve, however, during his stay at the hospital, the patient developed a digestive hemorrhage of a great abundance.
The oeso-gastroduodenal endoscopy, colonoscopy and entero-CT scan did not show any abnormality that could explain the hemorrhage.
The diagnosis of scurvy was suspected regarding hair loss, malnutrition, teeth loss, bruising and thrombocytopenia. It was confirmed by a low rate of vitamin C (2.1 mg/l ). The evolution with 1,5 g/day of Vitamin C was favorable. The melena disappeared and the thrombocytopenia and hemoglobin stabilized.

Conclusions: Scurvy is a potentially serious historical disease that has not completely disappeared despite an improvement in living standards. Its treatment is simple and inexpensive if we think about it.

« Back to ISTH 2020 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-digestive-hemorrhage-like-no-other/