Diagnostic pitfalls: case report of scurvy in a man with spinal cord injury

BACKGROUND: A 49-year-old man with spinal cord injury (SCI) developed a progressive purpuric rash and painful swelling of the lower extremities, in addition to chronic purpura over the ischial tuberosities. DESIGN: Case report. FINDINGS: Following an extensive workup for presumed vasculitis, a skin biopsy showed evidence of scurvy. Risk factors for scurvy included limited means of transportation, living alone, and alcohol abuse. CONCLUSIONS: Scurvy can be confused with disorders common among SCI patients, such as vasculitis, venous thrombosis, occult trauma, and pressure injury. Scurvy should be considered in the differential diagnosis of skin lesions, especially in individuals who abuse alcohol and live alone.