Abstract

A 62-year-old woman with a history of hypothyroidism and reflux presented to her primary care clinic to establish care and work-up chronic fatigue and constipation. Initial work-up showed a normal TSH, and no other lab abnormalities. Screening colonoscopy was completed which was normal. Further history revealed the patient had bleeding gums, without easy bleeding and bruising, and she was eating rice and olive almost exclusively. Additional testing showed an undetectable vitamin C level. She was treated with vitamin C supplementation, advised to increase intake of fruits and vegetables, but was lost to follow-up. Scurvy can present with a myriad of symptoms, from the classic mucocutaneous bleeding, bruising and corkscrew hairs, to depression, anxiety, and fatigue, and even seizures. Scurvy should be considered in elderly patients, and those with mental health and substance use disorders, as well as poor access to food. A dietary history can be helpful in elucidating the etiology of otherwise puzzling symptoms.

Keywords: Scurvy; Dietary history; Vitamin C; Constipation