{'fraction_non_alphanumeric': 0.024120603015075376, 'fraction_numerical': 0.008040201005025126, 'mean_word_length': 4.890532544378698, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Extensive bruising secondary to scurvy

A 42-year-old man presented to the emergency department with a 1-month history of lethargy and significant spontaneous bruising and pain over his thighs (Figs 1,2) and bleeding from his gums. Therewas no known trauma, and he had not had any significant bleeding history. His health was otherwise unremarkable. His social history was significant in that he had severe agoraphobia andwas livingwithhismother ina retirement village. She was recently moved into a hostel because of severe dementia. His diet over the past 5 years had consisted almost entirely of sausage rolls, meat pies, wheat cereal biscuits, peanut butter, chocolate cake andmilk. He had not had any vegetables or fresh fruit in over 5 years and was unable to cook for himself. In recent times, his shopping had been done by community-support staff and they had previously tried to encourage a better diet, but he was noncompliant. On examination, he appeared malnourished and had extensive ecchymoses and petechiae over the lower limbs and marked gingivitis. His blood tests on admission showed an undetectable ascorbic acid (vitamin C) level. He had normal electrolytes and renal function but decreased albumin of 29 g/L and total protein of 62 g/L. His vitamin B12, B1 and folate levels were normal. He was anaemic, with a haemoglobin level of 81 g/L and with normal white cells, platelets and coagulation studies. Scurvy (ascorbic acid deficiency) was classically described on long ship voyages but is now rarely seen in other than disadvantaged groups, although subclincal vitamin C deficiency may be more common. It should be considered in cases of unexplained bleeding, especially if there is follicular hyperkeratosis and ‘corkscrew’ hairs. The bleeding is thought to be related to defective collagen formation in small blood vessels. If untreated, scurvy is fatal as a result of infection or sudden cardiac death, but it invariably responds favourably to vitamin C repletion.