Correspondence

Medical Mystery: Extensive Ecchymosis — The Answer

N Engl J Med 2006; 354:419-420January 26, 2006

Article

To the Editor:

The Medical Mystery in the December 1 issue1 involved a 71-year-old man with lower-extremity ecchymosis (Figure 1Figure 1Ecchymosis on the Lower Extremities.) and gingivitis (Figure 2Figure 2Severe Gingivitis., arrows). He was a retired Army man living alone with a modest income. He had poor nutritional intake, had a history of 150 pack-years of smoking cigarettes, and consumed two glasses of red wine each day.

Scurvy was suspected and confirmed by a low level of ascorbic acid (3.6 μmol per liter; normal range, 30 to 40). Other nutritional deficiencies that were identified included those of folic acid (1.37 ng per milliliter [3.1 nmol per liter]; normal range, 3 to 17 ng per milliliter [6.8 to 38.5 nmol per liter]); calcium (1.96 mmol per liter; normal range, 2.22 to 2.61); and 25-hydroxyvitamin D (7 mmol per liter; normal range, 27 to 175). Ascorbic acid was given orally at a dose of 500 mg per day. Eight days later, the patient was able to walk alone, the ecchymosis gradually disappeared, and the congestive periodontitis was notably improved.

Denis Mulleman, M.D.
Philippe Goupille, M.D.
François Rabelais University, 37032 Tours CEDEX 1, France

1 References