TY - JOUR
T1 - Scurvy
T2 - a rare case in an adult
AU - Joshi, Rajat
AU - Gustas-French, Cristy N.
AU - Fanburg-Smith, Julie
AU - Helm, Klaus
AU - Flemming, Donald
N1 - Funding Information:
The authors would like to recognize Heidi Reinhard, MD Department of Pathology, Penn State Milton S. Hershey Medical Center for pathology contributions to the manuscript.
Publisher Copyright:
© 2018, ISS.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - A 69-year-old man presented with unilateral calf pain, swelling, and erythematous rash. He was initially treated with antibiotics for suspected cellulitis. A venous duplex ultrasound, performed to exclude deep venous thrombosis, revealed multiple heterogeneous hypoechoic foci of unknown etiology throughout the calf musculature. His condition did not improve with antibiotics, instead progressing to a necrotic ulcer along the medial malleolus. Clinical suspicion of vascular insufficiency or vasculitis prompted an extensive imaging work-up. CT and MRI revealed the intramuscular abnormalities observed on previous ultrasound represented foci of intramuscular hemorrhage. Marrow signal abnormality was also noted in the proximal tibia. A punch biopsy of the skin rash ultimately demonstrated distorted hair follicles with perifollicular inflammation and hemorrhage concerning for scurvy. The diagnosis was confirmed by low vitamin C levels and dietary history. A resurgence of scurvy has occurred in the pediatric population in recent years. However, this diagnosis remains uncommon in adults, with limited reports of the potential advanced imaging findings in the current literature.
AB - A 69-year-old man presented with unilateral calf pain, swelling, and erythematous rash. He was initially treated with antibiotics for suspected cellulitis. A venous duplex ultrasound, performed to exclude deep venous thrombosis, revealed multiple heterogeneous hypoechoic foci of unknown etiology throughout the calf musculature. His condition did not improve with antibiotics, instead progressing to a necrotic ulcer along the medial malleolus. Clinical suspicion of vascular insufficiency or vasculitis prompted an extensive imaging work-up. CT and MRI revealed the intramuscular abnormalities observed on previous ultrasound represented foci of intramuscular hemorrhage. Marrow signal abnormality was also noted in the proximal tibia. A punch biopsy of the skin rash ultimately demonstrated distorted hair follicles with perifollicular inflammation and hemorrhage concerning for scurvy. The diagnosis was confirmed by low vitamin C levels and dietary history. A resurgence of scurvy has occurred in the pediatric population in recent years. However, this diagnosis remains uncommon in adults, with limited reports of the potential advanced imaging findings in the current literature.
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U2 - 10.1007/s00256-018-3069-3
DO - 10.1007/s00256-018-3069-3
M3 - Article
C2 - 30259130
AN - SCOPUS:85053917402
SN - 0364-2348
VL - 48
SP - 977
EP - 984
JO - Skeletal Radiology
JF - Skeletal Radiology
IS - 6
ER -