RCPPHOTO/ShutterstockThe patient: Frank*, 46, a software engineer in Ontario, Canada
The symptoms: A sore, swollen leg and fatigue
The doctor: Dr. John David Neary, clinical teaching unit director, General Internal Medicine at St. Joseph’s Healthcare in Hamilton, Ontario
In September 2012, Frank got off a plane from England and went straight to the ER at St. Joseph’s with a sore, swollen right leg. Both he and the doctors on call suspected a blood clot—a risk after sitting still in a confined space for long periods—but an ultrasound showed nothing amiss, and Frank was sent home.
His symptoms continued, so he returned three weeks later and was sent home again. It was the end of October when he made his third trip to the hospital. By now, his right knee was red, puffy, and hot to the touch. Frank was admitted, diagnosed with cellulitis—a potentially serious bacterial skin infection—and given broad-spectrum antibiotics. He showed some improvement after two days and was discharged. Here are some other signs of disease your skin can reveal.
Three months after the onset of his symptoms, Frank’s leg flared up again. He felt lethargic and was having trouble walking. He’d also developed bruises on the backs of his legs. Doctors inserted a needle into his knee to extract what they believed would be fluid, a sign of infection. They drew blood instead. Frank’s physicians struggled to arrive at a diagnosis that made sense.
The patient was slightly anemic and had developed pinpricks of blood (known as petechiae) on his legs. This suggested he was bleeding from somewhere, but a bleeding disorder would cause either deep or superficial bleeding, not both.
“His symptoms didn’t fit together,” says Dr. John Neary, who was a resident when he heard about the case. “I said to my mentor, ‘Maybe it’s scurvy.’”
He was just throwing out the suggestion for a laugh. But when they examined the patient more closely, they noticed the petechiae were centered around his hair follicles, and the hairs on his legs had curled into a corkscrew shape, both of which are signs of tissue fragility. Suddenly, Neary’s far-fetched diagnosis became more plausible.
Scurvy is caused by a severe deficiency in vitamin C, a nutrient that’s essential for maintaining the integrity of the skin, connective tissue, bones, gums, and blood vessel walls. Common on long ship voyages in the 17th century, the disease is still diagnosed in the elderly, anorexics, alcoholics, and low-income families who can’t afford or don’t have easy access to fresh fruits or vegetables. These are the signs of a vitamin C deficiency you’re probably ignoring.
Neary and his supervisor asked Frank about his daily habits. “We discovered that he ate the same thing every day. All of it was heavily processed and out of a box.” Now they were convinced that scurvy was the correct diagnosis.
The doctors hadn’t encountered scurvy before, but they learned that it requires a blood test for vitamin C, and that the results could take up to three weeks.
Rather than wait for the results, they gave the patient a 500-milligram vitamin C supplement. Two days later, his bruises faded and his knee swelling diminished. By the third day, he could walk comfortably and return home.
The test results eventually showed that Frank had vitamin C levels below the limit of what the lab could detect. Left untreated, scurvy can cause jaundice, edema (swelling caused by fluid buildup), joint pain, bruising, bleeding gums, and potentially fatal heart problems.
Frank made a full recovery and vowed to eat a healthier, more varied diet, but he also takes a multivitamin and vitamin C supplement every day, just to be safe. To make sure you’re getting enough vitamin C in your diet, eat these foods with more vitamin C than an orange.
*Name withheld to protect patient privacy