Histologic examination of the punch biopsy specimens demonstrated hemosiderin deposition around the hair follicle with extravasated erythrocytes. There was no evidence of vasculitis. Laboratory studies revealed moderate anemia, no detectable serum vitamin C, and decreased levels of vitamins A, B6, D, E, and zinc. Laboratory findings for anti–double-stranded DNA antibody, ribonucleoprotein autoantibody, rheumatoid factor, human immunodeficiency virus blood tests, hepatitis B antigen, Epstein-Barr virus antibody, erythrocyte sedimentation rate, cryoglobulin, thyrotropin, platelet level, and peripheral blood smear studies were all negative or normal. Clinical presentation combined with microscopic and serum findings confirmed a diagnosis of scurvy. The patient was treated with intravenous vitamin C and oral nutrition and discharged home after several days in the hospital.
Fatigue and Lower-Extremity Ecchymosis in a 36-Year-Old Woman—Diagnosis. Arch Dermatol. 2012;148(9):1073–1078. doi:10.1001/archderm.148.9.1073-h
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