My 3-year-old daughter likes to play pirates and so the topic of scurvy has come up once or twice in the midst of our adventures. She knows she won’t get scurvy thanks to her regular consumption of citrus fruits and gummy vitamins. The diagnosis on this biopsy, I have to admit, was given to me on the requisition form by the submitting dermatologist. The patient presented with perifollicular hemorrhage of the lower extremities, and had a history of alcohol abuse. Lucky for me, he did a biopsy and I was able to add another interesting case to my files. The follow-up laboratory studies showed a plasma Vitamin C of <0.1 mg/dL with a reference range of 0.4-2 mg/dL. That’s deficient!
Cutaneous findings in scurvy are perifollicular hemorrhage affecting the legs, follicular plugging, dry skin, petechiae and subungual splinter hemorrhages, swollen and bleeding gums, and poor wound healing.
The biopsy from the leg shows a hair follicle with a corkscrew or coiled appearance and associated perifollicular lymphocytic infiltrate and hemorrhage. Sometimes keratin plugging is described, but I didn’t see that in this biopsy. These findings are often what is described in patients with scurvy.