ABSTRACT
Scurvy is taught in history class and most doctors consider it a disease of the past. However, several studies show that vitamin C deficiency is highly prevalent among alcoholics, but also in elderly, people with low socioeconomic status, mental disorders or a restricted diet (7.1 - 25%). Besides the classical signs of scurvy, individuals exhibit a wide variety of symptoms. We present three recent cases of patients with vitamin C deficiency, with symptoms of bleeding, lethargy and edema, in whom supplementation greatly improved symptoms. As our cases illustrate having a high suspicion of scurvy and starting ascorbic acid might be a low cost and very effective intervention.
Subject(s)
Ascorbic Acid Deficiency , Mental Disorders , Scurvy , Humans , Aged , Scurvy/complications , Scurvy/diagnosis , Ascorbic Acid/therapeutic use , Ascorbic Acid Deficiency/complications , Ascorbic Acid Deficiency/diagnosisABSTRACT
BACKGROUND: In infection with the enterohaemorrhagic Escherichia coli (EHEC), toxins produced by the bacteria can induce the potentially lethal disease haemolytic uremic syndrome (HUS). CASE DESCRIPTION: A 71-year-old woman was seen at the Emergency Department with abdominal cramps and bloody diarrhoea. Diagnostic tests revealed ischaemia of the intestinal mucosa. A few days after admission the patient developed acute malfunction of the kidneys and thrombocytopenia. HUS was diagnosed, which was later shown to be caused by infection with EHEC. The patient was treated with plasmapheresis and haemodialysis, which brought her kidney function back to normal. History taking revealed that the patient had visited northern Germany where the EHEC epidemic was raging. CONCLUSION: In cases of bloody diarrhoea, clinicians should consider infection with EHEC - a bacterium for which antibiotics are not appropriate treatment. If the infection becomes complicated by the development of HUS, then the treatment of choice should be administration of fluids, and haemodialysis possibly combined with plasmapheresis.
