RESUMO
A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have Klebsiella bacteraemia secondary to urinary source. Skin biopsy showed dermal haemorrhage without vessel inflammation. Vitamin C levels were low confirming the diagnosis of scurvy.
Assuntos
Ácido Ascórbico , Colectomia/efeitos adversos , Neoplasias Colorretais , Equimose , Desnutrição , Apoio Nutricional/métodos , Escorbuto , Antineoplásicos Imunológicos/uso terapêutico , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/sangue , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Colectomia/métodos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/secundário , Neoplasias Colorretais/terapia , Diagnóstico Diferencial , Equimose/sangue , Equimose/diagnóstico , Equimose/etiologia , Feminino , Humanos , Klebsiella/isolamento & purificação , Extremidade Inferior , Desnutrição/etiologia , Desnutrição/terapia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Escorbuto/sangue , Escorbuto/etiologia , Escorbuto/fisiopatologia , Escorbuto/terapia , Pele/patologia , Resultado do Tratamento , Vitaminas/administração & dosagemAssuntos
Medicina Naval/história , Escorbuto/história , Citrus , História do Século XVIII , Humanos , Masculino , Escorbuto/terapia , NaviosRESUMO
El escorbuto es una enfermedad causada por la deficiencia de vitamina C o ácido ascórbico. Sus manifestaciones clínicas son variadas debido a que esa vitamina es un cofactor de enzimas que intervienen en numerosos procesos, como la síntesis de colágeno y la absorción de diferentes nutrientes. La expresión cutánea característica son las petequias foliculares con pelos en cuello de cisne y en tirabuzón. El compromiso mucoso se manifiesta como hipertrofia y hemorragia gingival, gingivitis y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática o leucocitaria. El tratamiento se basa en el aporte suplementario de esa vitamina. Se presenta el caso de un paciente de 32 años con escorbuto debido a una dieta casi exclusivamente a base de harinas y carente de frutas y verduras. (AU)
Scurvy is a disease caused by vitamin C deficiency (also called ascorbic acid). Its clinical manifestations are varied because this vitamin is a cofactor of enzymes that take part in numerous processes, such as the synthesis of collagen and the absorption of different nutrients. Cutaneous expression of scurvy is follicular petechiae with corkscrew hairs. Mucous involvement manifests as gingival hypertrophy and bleeding, gingivitis and loss of teeth. The diagnosis of this entity is clinical and can be confirmed by plasma or leukocyte vitamin C dosing. The treatment consists of vitamin C supplementation. We present a 32-year-old male patient with scurvy secondary to a diet based almost exclusively on flour and lacking in fruits and vegetables. (AU)
Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Escorbuto/diagnóstico , Ácido Ascórbico/uso terapêutico , Escorbuto/terapia , Vitaminas/uso terapêuticoAssuntos
Escorbuto/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Escorbuto/etiologia , Escorbuto/terapiaRESUMO
While scurvy is considered to be a rare disease in the modern era, the disease still presents in certain populations with nutritional deficiencies such as those with poor nutritional absorption secondary to gastrointestinal disorders and in patients with poor nutritional intake. We present a case of scurvy in a patient who had eosinophilic oesophagitis which limited his oral intake. He presented with the classic symptoms of scurvy including a perifollicular rash, arthralgia, gingivitis and anaemia. He was treated with intravenous vitamin C initially followed by an oral course after which he showed improvement. This case demonstrates that it is important to consider vitamin C deficiency in patients with who present with anaemia and bleeding stigmata specifically in those who have poor nutritional intake. Furthermore, additional consideration should be given to patients with malnutrition as part of the preoperative evaluation.
Assuntos
Anemia , Ácido Ascórbico , Esofagite Eosinofílica , Escorbuto , Administração Intravenosa , Anemia/sangue , Anemia/diagnóstico , Anemia/etiologia , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/sangue , Biópsia/métodos , Diagnóstico Diferencial , Esofagite Eosinofílica/complicações , Esofagite Eosinofílica/patologia , Esofagite Eosinofílica/fisiopatologia , Humanos , Ferro/sangue , Exame Físico/métodos , Escorbuto/diagnóstico , Escorbuto/etiologia , Escorbuto/fisiopatologia , Escorbuto/terapia , Índice de Gravidade de Doença , Pele/patologia , Resultado do Tratamento , Vitaminas/administração & dosagem , Vitaminas/sangueRESUMO
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.
Assuntos
Fármacos Dermatológicos/uso terapêutico , Imunoterapia/métodos , Infliximab/uso terapêutico , Úlcera da Perna/diagnóstico , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/terapia , Escorbuto/diagnóstico , Escorbuto/terapia , Idoso , Diagnóstico Tardio , Diagnóstico Diferencial , Feminino , Humanos , Úlcera da Perna/terapia , Pioderma Gangrenoso/epidemiologia , Resultado do Tratamento , OcidenteAssuntos
Deficiência de Ácido Ascórbico/complicações , Ácido Cítrico/uso terapêutico , Escorbuto/etiologia , Ácido Cítrico/história , Citrus , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Escorbuto/história , Escorbuto/terapiaAssuntos
Abscesso/etiologia , Artralgia/etiologia , Complicações Pós-Operatórias/etiologia , Escorbuto/complicações , Adulto , Idoso , Articulação do Tornozelo , Ácido Ascórbico/administração & dosagem , Deficiência de Ácido Ascórbico/complicações , Feminino , Hematoma/etiologia , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Escorbuto/terapiaRESUMO
BACKGROUND: Scurvy is a rare entity in developed countries and the diagnosis may often be delayed resulting in unnecessary investigations and/or potentially severe complications. A recent increase in the number of patients diagnosed with scurvy in our hematology clinics indicated the need to review the literature on the diagnosis and optimal management of similar patients. METHODS: We conducted a retrospective chart review of patients referred to hematology at our tertiary care centre between 2010 and 2018, who were ultimately diagnosed with scurvy. Data collected from electronic medical records included baseline characteristics, clinical features on presentation, bloodwork results from initial consultation, treatment plan as well as response to treatment. FINDINGS: Twenty-two adults patient had a diagnosis of scurvy with a mean vitamin C level of 6⯵mol/L. Iron deficiency anemia (54%) and gastrointestinal disorders (54%) were the most common comorbidities noted in our cohort. Proton-pump inhibitors use was noted in 54% of patients. Bleeding (45%) and bruising (45%) were the most commonly reported clinical features. Eleven patients received oral supplementation, five had intravenous (IV) vitamin C and six were not treated. Two patients required a transition from oral to IV supplementation. Vitamin C dosing ranged between 250 and 2000â¯mg and the frequency varied from daily for oral therapy to every few weeks or months for IV. INTERPRETATION: Awareness of scurvy and its associated risk factors and clinical presentation is important in the evaluation of a patient with bleeding tendency. Treatment plan should be individualized, and a careful review of patients' diet, medial history and medications is warranted.
Assuntos
Contusões/etiologia , Hemorragia/etiologia , Escorbuto/patologia , Adulto , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/sangue , Dieta , Humanos , Anamnese , Medicina de Precisão/métodos , Inibidores da Bomba de Prótons , Estudos Retrospectivos , Escorbuto/etiologia , Escorbuto/terapiaAssuntos
Diabetes Mellitus , Medicina Naval , Médicos , Pesquisa/organização & administração , Escorbuto , Sociedades Médicas/organização & administração , Diabetes Mellitus/etiologia , Diabetes Mellitus/terapia , História do Século XVIII , História do Século XXI , Humanos , Medicina Naval/história , Defesa do Paciente/história , Defesa do Paciente/normas , Defesa do Paciente/tendências , Médicos/história , Parcerias Público-Privadas/história , Parcerias Público-Privadas/organização & administração , Parcerias Público-Privadas/tendências , Pesquisa/história , Pesquisa/tendências , Escorbuto/história , Escorbuto/terapia , Sociedades Médicas/história , Sociedades Médicas/tendências , Cirurgiões/história , Reino UnidoAssuntos
Anemia de Fanconi , Transplante de Células-Tronco Hematopoéticas , Escorbuto , Tomografia Computadorizada por Raios X , Aloenxertos , Criança , Anemia de Fanconi/sangue , Anemia de Fanconi/diagnóstico por imagem , Anemia de Fanconi/genética , Anemia de Fanconi/terapia , Feminino , Humanos , Escorbuto/sangue , Escorbuto/diagnóstico por imagem , Escorbuto/genética , Escorbuto/terapiaRESUMO
This article discusses the clinical appearance, differential diagnoses, and treatment considerations of corneal disease in the most common domesticated species of rodent: mouse, rat, chinchilla, and guinea pig. Many corneal diseases are related to inbred strains of either research or pet rodents. Diseases are complicated by husbandry and treatment-related challenges in this small, social species. This article is broken down by species, first discussing normal anatomy, then discussing commonly encountered diseases, and concluding with treatment considerations.
Assuntos
Conjuntivite/veterinária , Ceratoconjuntivite/veterinária , Doenças dos Roedores/diagnóstico , Escorbuto/veterinária , Animais , Chinchila , Conjuntivite/diagnóstico , Conjuntivite/terapia , Córnea/anatomia & histologia , Cobaias , Ceratoconjuntivite/diagnóstico , Ceratoconjuntivite/terapia , Camundongos , Ratos , Doenças dos Roedores/terapia , Roedores , Escorbuto/diagnóstico , Escorbuto/terapiaRESUMO
Over a five-month period, clinicians in Tana River County Kenya observed an increasing number of patients presenting to health facilities with a common collection of symptoms including fevers, joint pains and gum hypertrophy. After initial investigative and management strategies failed to reveal a diagnosis, patients were empirically commenced on ascorbic acid for presumed scurvy. This strategy resulted in the rapid resolution of symptoms in 65 patients within two weeks.
Assuntos
Surtos de Doenças , Escorbuto/epidemiologia , Ácido Ascórbico/uso terapêutico , Diagnóstico Diferencial , Humanos , Quênia/epidemiologia , Escorbuto/diagnóstico , Escorbuto/terapiaAssuntos
Anemia/diagnóstico , Anemia/terapia , Ácido Ascórbico/administração & dosagem , Escorbuto/diagnóstico , Escorbuto/terapia , Anemia/sangue , Antioxidantes/administração & dosagem , Ácido Ascórbico/sangue , Deficiência de Ácido Ascórbico/sangue , Deficiência de Ácido Ascórbico/complicações , Deficiência de Ácido Ascórbico/diagnóstico , Dieta Saudável/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Escorbuto/sangueAssuntos
Contusões/diagnóstico , Contusões/terapia , Escorbuto/diagnóstico , Escorbuto/terapia , Idoso , Ácido Ascórbico/administração & dosagem , Contusões/etiologia , Contusões/patologia , Diagnóstico Diferencial , Suplementos Nutricionais , Feminino , Humanos , Escorbuto/complicações , Escorbuto/patologiaRESUMO
Though James Lind is renowned as a pioneer of the clinical trial, he records the 1747 trial aboard the Salisbury in passing, never followed up on it, never campaigned for clinical trials as a means of medical discovery, and eventually pronounced scurvy an insoluble enigma. The case can be made that in confessing his lack of an unfailing remedy for scurvy and his trouble making sense of the disease's behaviour, Lind did medicine a greater service than by conducting his now-famous trial. At the time, medical progress was hindered by the all-too-common practice of proclaiming success and concealing failure. With his ethos of candour Lind challenged this practice by example; he may have been among the first to do so. Within a few years of the publication of the third and final edition of his A Treatise of the Scurvy, medical tracts began to appear in which the authors (some of whom knew Lind's treatise) took issue with the practice of concealing failure. A concerted attack on the suppression of evidence vivified the concept of evidence itself. Today, with the selective publication of findings distorting the medical literature, Lind's story of admitted failure holds great meaning.
Assuntos
Ensaios Clínicos como Assunto/história , Escorbuto/história , Revelação da Verdade , Ensaios Clínicos como Assunto/ética , História do Século XVIII , Escorbuto/terapia , Falha de Tratamento , Reino UnidoRESUMO
RATIONALE: Scurvy is often diagnosed at the state of well-established signs as, for example, skin and visceral purpura, gums involvement, loss of healthy teeth, which derive mostly from disturbance of collagen metabolism. Little is known about the state of latent scurvy, which symptoms are nonspecific and may mimic more common conditions such as weakness, leg pain, and muscle aching. PATIENT CONCERNS: We report 3 cases of extreme lassitude and leg pain in alcoholics. In 2 of the 3 cases, discreet classic symptoms such as petechiae or hyperkeratosis of the legs involving collagen metabolism were also present. DIAGNOSES: Latent scurvy has been diagnosed thanks to historical experimental data reporting and undetectable ascorbic acid levels. INTERVENTIONS: In addition to the treatments recommended by the French Alcohol Society, patients were given oral vitamin C 500âmg to 1000âmg per day for at least three months. OUTCOMES: Vitamin C supplementation allowed the regression of the symptoms, greatly improved the quality of life, and gave the possibility to return to work. Cartinine, requiring vitamin C for its hydroxylation, is an essential cofactor in the transport of long-chain fatty acid into mitochondrial matrix. Therefore, it plays an important role in energy production via beta-oxidation. It is thought that carnitine metabolism impairment is responsible for weakness or muscle aching. LESSONS: We recommend being aware of the possibility of latent scurvy in chronic alcohol abusers. The vitamin C supplementation and dietetic recommendation eating fresh fruit and vegetables may help to cure tiredness and to return more easily to socialization and to work.