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CPC10: Mediterranean masquerade: clinicopathogenetic analysis of an unusual presentation

At each follow-up visit, the skin lesions had resolved, coinciding with his hospital admissions for nutritional support. A diagnosis of scurvy was finally made on repeat review, based on a strong clinical suspicion, biopsy findings and a poor dietary history in a nursing home patient with AN. The diagnosis was substantiated by laboratory investigations showing low vitamin C levels < 5 7 μmol L. He was treated with vitamin C replacement 100 mg three times a day following which he had no further recurrences of these skin lesions. Scurvy is a clinical diagnosis reinforced by relevant dietary history. Early recognition of clinical signs and symptoms in scurvy facilitate prompt diagnosis and management in a condition that is easy to treat. The absence of classical signs and the presence of bullae made this case a diagnostic challenge. Therefore, this case throws light on the importance of a thorough history and vigilance in an institutionalized patient with AN presenting with a bullous purpuric shin rash with no histological evidence of vasculitis.