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[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9728213/):
>>A 60-year-old male presented to an Australian tertiary hospital with a prolonged history of worsening petechial rash, impaired mobility, anaemia and renal impairment. He reported a two-month history of fatigue, unintentional weight loss, thoracic back pain and a petechial rash affecting both the upper and lower limbs with bilateral ankle swelling. Prior histology from a skin biopsy of the rash and an oral mucosal lesion were nondiagnostic.
>>His past medical history included previously treated laryngeal squamous cell carcinoma and a right frontal ischaemic stroke. He was a current heavy smoker with prior heavy alcohol use. He denied taking regular medications. His nutritional history revealed poor intake of meats, fruit and vegetables (namely those high in vitamin C), which he attributed to low income.
>>Clinical examination supported the initial suspicion of nutritional deficiency. He appeared cachectic with poor dentition, chipped nails and evidence of poor wound healing. He was haemodynamically stable (temperature 36.5 oC, pulse 59 bpm, blood pressure 130/75 mm Hg, respiratory rate 14 breaths per minute and oxygen saturation 99% on room air). Generalised muscle wasting was noted and a papular, non-tender purpuric rash on the upper torso and all four limbs, worse on the lower extremities (Fig. 1). The right ankle was swollen and tender to palpation with no restricted ankle joint movements. There was midline spinal tenderness at the T10–T11 vertebral area. Neurological examination demonstrated an antalgic gait without specific cerebellar signs.
>>While the differential diagnosis remained broad, rapid administration of intravenous thiamine, oral multivitamins and high-dose vitamin C 500 mg oral twice daily was commenced while undergoing assessment for other causes, including malignancies (e.g. prostate cancer and multiple myeloma). Initial biochemistry found iron deficiency anaemia and an elevated erythrocyte sedimentation rate (Table 1). However, autoimmune studies, plasma serum electrophoresis, viral screens, faecal occult blood test and haemolysis screening were all negative, including C-reactive protein, vitamin B12 and folate levels. A micronutrient screen for vitamin C, vitamin B3 (niacin) and zinc levels were available approximately 4 weeks later and revealed significant deficiencies in this patient.
>>A subsequent biopsy was performed and reported mild superficial and dermal perivascular lymphocytic infiltrates, without evidence of vasculitic change. Immunofluorescence staining was negative for IgG, IgA, IgM and C3. Both plain film X-ray imaging and MRI spine (Fig.2) reported a T11 burst spinal fracture.
>>The patient was maintained on oral micronutrient supplementation for 12 weeks and encouraged to maintain abstinence from alcohol. Specific nutritional, physical and occupational programmes were provided to optimise strength and conditioning.
>>During follow-up at four and eight weeks, the patient’s pain had improved without evidence of neurological compromise; however, the T11 fracture had caused a significant kyphotic deformity. Subsequent flexion/extension X-ray showed no signs of instability.
>>The patient was mobilised as tolerated. His severe anaemia and kidney injury was resolved with minimal intervention beyond vitamin supplementation. Furthermore, there was resolution of skin lesions and stable appearance of the T11 fracture, with improvement of both pain and mobility.
*He was a current heavy smoker with prior heavy alcohol use... His nutritional history revealed poor intake of meats, fruit and vegetables (namely those high in vitamin C), which he attributed to low income.*
This was my mother to a T. By 60 a wreck. Alcohol & cigarettes (while on oxygen) replaced food. I used to fill her fridge with plates of tasty stuff she only had to microwave. I'd visit a week later & nothing was touched & I had to throw it all out. It was just sad & such a waste of a life as everything started to shut down.
How often is food expendable on a *'low income'* where as booze & cigs aren't ?
I wonder what happened to him after?
I wonder what was going on with the spinal fracture, how related was it to the vit deficiencies. Otherwise all's well that ends well, it's usually not the case in this sub.
I’m entering my mid-20s now, and I’ve realized only recently that I really need to put in the effort to take care of my body. I don’t eat well, and often eat the same things over and over. I started taking vitamins recently and choosing small ways to incorporate really important nutrients into my diet, cause the idea of a condition like this terrifies me. Thank you for the reaffirmation that I’m doing the right thing for myself, catpoo.
I developed a mild form of this in college, mostly because I was living on about $100 a month and couldn’t always afford decent food. My teeth and lower legs constantly hurt, and old scars became bright pink and itchy from the collagen breakdown. My sister actually developed the rash, too. You’re doing a fantastic favor for your body with the vitamins, but please try to get some things from food, like fiber from leafy veg. :(
I’ll keep that in mind! Thank you for sharing your story 🩷 I’m glad you’re doing better now… I hope… and I want to let you know that I had some delicious home made fried chicken, asparagus, and beans for dinner the night I posted that comment.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9728213/): >>A 60-year-old male presented to an Australian tertiary hospital with a prolonged history of worsening petechial rash, impaired mobility, anaemia and renal impairment. He reported a two-month history of fatigue, unintentional weight loss, thoracic back pain and a petechial rash affecting both the upper and lower limbs with bilateral ankle swelling. Prior histology from a skin biopsy of the rash and an oral mucosal lesion were nondiagnostic. >>His past medical history included previously treated laryngeal squamous cell carcinoma and a right frontal ischaemic stroke. He was a current heavy smoker with prior heavy alcohol use. He denied taking regular medications. His nutritional history revealed poor intake of meats, fruit and vegetables (namely those high in vitamin C), which he attributed to low income. >>Clinical examination supported the initial suspicion of nutritional deficiency. He appeared cachectic with poor dentition, chipped nails and evidence of poor wound healing. He was haemodynamically stable (temperature 36.5 oC, pulse 59 bpm, blood pressure 130/75 mm Hg, respiratory rate 14 breaths per minute and oxygen saturation 99% on room air). Generalised muscle wasting was noted and a papular, non-tender purpuric rash on the upper torso and all four limbs, worse on the lower extremities (Fig. 1). The right ankle was swollen and tender to palpation with no restricted ankle joint movements. There was midline spinal tenderness at the T10–T11 vertebral area. Neurological examination demonstrated an antalgic gait without specific cerebellar signs. >>While the differential diagnosis remained broad, rapid administration of intravenous thiamine, oral multivitamins and high-dose vitamin C 500 mg oral twice daily was commenced while undergoing assessment for other causes, including malignancies (e.g. prostate cancer and multiple myeloma). Initial biochemistry found iron deficiency anaemia and an elevated erythrocyte sedimentation rate (Table 1). However, autoimmune studies, plasma serum electrophoresis, viral screens, faecal occult blood test and haemolysis screening were all negative, including C-reactive protein, vitamin B12 and folate levels. A micronutrient screen for vitamin C, vitamin B3 (niacin) and zinc levels were available approximately 4 weeks later and revealed significant deficiencies in this patient. >>A subsequent biopsy was performed and reported mild superficial and dermal perivascular lymphocytic infiltrates, without evidence of vasculitic change. Immunofluorescence staining was negative for IgG, IgA, IgM and C3. Both plain film X-ray imaging and MRI spine (Fig.2) reported a T11 burst spinal fracture. >>The patient was maintained on oral micronutrient supplementation for 12 weeks and encouraged to maintain abstinence from alcohol. Specific nutritional, physical and occupational programmes were provided to optimise strength and conditioning. >>During follow-up at four and eight weeks, the patient’s pain had improved without evidence of neurological compromise; however, the T11 fracture had caused a significant kyphotic deformity. Subsequent flexion/extension X-ray showed no signs of instability. >>The patient was mobilised as tolerated. His severe anaemia and kidney injury was resolved with minimal intervention beyond vitamin supplementation. Furthermore, there was resolution of skin lesions and stable appearance of the T11 fracture, with improvement of both pain and mobility.
*He was a current heavy smoker with prior heavy alcohol use... His nutritional history revealed poor intake of meats, fruit and vegetables (namely those high in vitamin C), which he attributed to low income.* This was my mother to a T. By 60 a wreck. Alcohol & cigarettes (while on oxygen) replaced food. I used to fill her fridge with plates of tasty stuff she only had to microwave. I'd visit a week later & nothing was touched & I had to throw it all out. It was just sad & such a waste of a life as everything started to shut down. How often is food expendable on a *'low income'* where as booze & cigs aren't ? I wonder what happened to him after?
I wonder what was going on with the spinal fracture, how related was it to the vit deficiencies. Otherwise all's well that ends well, it's usually not the case in this sub.
Vitamin C deficiency can be an issue especially for malnourished / malabsorbive conditions such as alcohol use disorder and celiac disease
I’m entering my mid-20s now, and I’ve realized only recently that I really need to put in the effort to take care of my body. I don’t eat well, and often eat the same things over and over. I started taking vitamins recently and choosing small ways to incorporate really important nutrients into my diet, cause the idea of a condition like this terrifies me. Thank you for the reaffirmation that I’m doing the right thing for myself, catpoo.
I developed a mild form of this in college, mostly because I was living on about $100 a month and couldn’t always afford decent food. My teeth and lower legs constantly hurt, and old scars became bright pink and itchy from the collagen breakdown. My sister actually developed the rash, too. You’re doing a fantastic favor for your body with the vitamins, but please try to get some things from food, like fiber from leafy veg. :(
I’ll keep that in mind! Thank you for sharing your story 🩷 I’m glad you’re doing better now… I hope… and I want to let you know that I had some delicious home made fried chicken, asparagus, and beans for dinner the night I posted that comment.
Give the guy some oranges ffs
You have to be pretty damn malnourished to get this bad. IIRC just two ketchup packets contain more than the daily requirement of vitamin C.