Diagnostic dilemma: A woman got unusual bruising from a massage gun. It turned out she had scurvy.
The patient: A 37 -year -old woman in Philadelphia
Symptoms: The patient went to the emergency room after four days of pain, swelling and bruising on the upper part of her left knee. She reported that these symptoms appeared after using a massage pistol on her leg.
Doctors have seen bruises on its thigh, knee and calf, with swelling but no joint lesions or blood clots on scans. They advised the patient to stop using the massage pistol, continuing their drug diagram and monitoring later.
A few weeks later, she returned with shortness of breath and stunning, and she still had bruises on the leg. An MRI of the leg has shown swelling of the fabrics and a small muscle bruisingGenerally caused by trauma blinked with the fabric. Blood analyzes have revealed that its red blood cells and his hemoglobin – the part of the blood which carries oxygen – had dropped to dangerously low levels.
Sulflling that the patient can have anemia due to an iron deficiency, the medical team also checked her iron levels and found that he was low. To seek a potential source of blood loss, doctors carried out stool tests and made stomach and colon glasses, which were all normal.
The patient was released with a prescription for daily iron tablets and weekly intravenous iron, but they failed to maintain her hemoglobin level. She then received several blood transfusions, each transfusion briefly raising her figures, only to fall again in a week. The concerns about its low hemoglobin levels prompted doctors to suspend their anticoagulants and have a intrauterine device Placed, to stop all menstrual bleeding.
About six weeks in this decline, she returned to the emergency room with chest pain, night sweats, weight loss and worsening. His lungs seemed clear, but the scans showed that the right side of his heart was extended and weak, and the pressures in his lungs were very high, a condition called Pulmonary hypertension. Its oxygen levels have worsened overnight, so that doctors transferred it to intensive care. At that time, the doctors noticed that she had tiny red spots around the hair follicles on her legs and that the hairs twisted in a bowl; She also had swollen and purplish gums.
The diagnosis: Red spots, corkscrew and swollen gums were classic signs of vitamin C deficiency, and tests confirmed that its level of vitamin C was undetectable. During their other interrogation, she then pointed out that the citrus fruits gave her hives, so she had avoided them for years. (Additional fruits and vegetables can also be good sources of vitamin C; Women ‘doctors not noted if she had consumed one of these other foods.)
Without vitamin C, the body cannot build collagenThe scaffolding that supports blood vessels and tissues. The fragile vessels flee, the bruises linger, the wounds heal badly and, in rare cases, the strain can affect the function of the heart and the lungs.
Treatment: Doctors started the patient with high -dose oral supplements and the reversal was dramatic. In 48 hours, it was stable enough to leave intensive care. It was then released with a prescription of vitamin C supplements, a multivitamin containing iron and drugs for its pulmonary hypertension.
In the coming weeks, its blood numbers have increased without more transfusions, its bruises and its swelling of gum has faded and its breathing has improved. His blood thinness has been restarted safely. In the six months following the release, she no longer needed medication for pulmonary hypertension, her heart function and her scans returned to normal, and she was back to exercise as she had done before the murderous event.
Which makes the case unique: Scurvy We generally remember the disease of a historic sailor, but this form of malnutrition can still affect people these days.
Most cases of scorbut cause Fatigue, easy or light bruisingBut this patient developed dependent transfusion anemia, which means that she needed regular blood transfusions to maintain her number of blood. His condition was so severe that it did not respond to iron therapy – a rare occurrence described only occasionally in the medical literature.
It has also developed high pulmonary pressure with a constraint in the right side of the heart, a rare complication of scorbut which generally only improves when vitamin C is replaced, and not by standard drugs for the treatment of pulmonary hypertension.
“The current case recalls that scurvy continues to occur in the United States and highlights its potential severity and clinical characteristics,” wrote doctors in a Case report. “He also highlights the importance of a review of food history, especially when a diagnosis is elusive.”
For more intriguing medical cases, consult our Diagnostic dilemma archives.
This article is for information only and is not supposed to offer medical advice.
