BI29: Case series of vasculitis, iron deficiency anaemia and lymphopenia in patients with scurvy

M. Ebadian, M.-W. Lam, A. Barbieri and V. Shpadaruk

Northampton General Hospital NHS Trust, Northampton, UK

Vitamin C deficiency, otherwise known as scurvy, can lead to various symptoms and its clinical features can be easily confused with conditions such as vasculitis, systemic lupus erythematosus or coagulopathy. Skin changes include petechial, perifollicular haemorrhage and bruising, and it can often be misinterpreted as a systemic vasculitis. We present three cases with history of anaemia, lymphopenia, petechial and low vitamin C levels. Our literature review suggested that low vitamin C level is a rare but important cause of anaemia, and it can affect up to 80% of patients with scurvy. If not considered, it can lead to extensive investigations and repeated blood transfusions, heart failure and death. Vitamin C also has an important role in immune function. Preliminary evidence indicates that vitamin C can regulate T-cell and other lymphoid and myeloid cell maturation. Lymphopenia associated with scurvy is less often reported and if not considered can lead to low immunity, poor healing and sepsis. Scurvy is often underdiagnosed, especially as it is thought to be rare in the developed world. However, we believe that owing to current nutrient intake levels, and the storage and packaging of fruits and vegetables, it may be more common than previously assumed. Studies have shown that ascorbic acid in packaging, prolonged exposure to air (> 120 min) and temperatures > 4–5 °C significantly decrease the stability of vitamin C. The level of ascorbic acid in peeled and cut fruits stored at 0 °C decreases by up to 25%. In summary, our case increases awareness of this uncommon skin condition and highlights less-acknowledged laboratory findings that could potentially lead to a diagnosis of scurvy: anaemia, low iron and lymphopenia, especially in high-risk patients such as people on diets, people with intestinal malabsorption, the elderly population and alcoholics.