Histopathologic examination revealed follicular hyperkeratosis, a coiled hair emanating from the follicular infundibulum, and perifollicular hemorrhage with hemosiderin deposition, consistent with the diagnosis of scurvy. No evidence of vasculitis was found. The patient's serum ascorbic acid level was found to be lower than 0.12 mg/dL (6.8 µmol/L) (reference range, 0.20-1.90 mg/dL [11.4-107.9 µmol/L]), further confirming the clinical diagnosis.
Oral multivitamin and supplemental vitamin C therapy was initiated at a dosage of 500 mg twice daily. Also, dietary counseling was provided. The patient returned for evaluation 2 weeks later, at which time he had nearly complete resolution of the pain in his left foot. In addition, his foot was no longer swollen and the purpura overlying it had faded. The large ecchymoses on his thighs and buttocks, the perifollicular hemorrhages, the palatal petechiae, and the mass on his right forearm had all resolved.
Palpable Purpura in an Elderly Man—Diagnosis. Arch Dermatol. 2003;139(10):1363-1368. doi:10.1001/archderm.139.10.1363-a