Question:

A 70-year-old man has ecchymoses, perifollicular petechiae, and swelling of the gingiva. He has lived alone since the death of his wife 2 years ago. His diet consists primarily of cola and hot dogs. Which of the following is the most likely diagnosis?

Correct Answer: E.  Scurvy

Vitamin C deficiency (scurvy) classically presents with ecchymoses, petechaie, and gingival swelling. Vitamin C is necessary for the production of collagen; its deficiency results in a tendency towards weakened tissues and bleeding.

Beriberi is due to a deficiency of thiamine (B1). It may present as either “wet” (high-output heart failure and peripheral edema) or “dry” (mostly peripheral neuritis and paralysis). Either can also present with Wernicke’s encephalopathy (ataxia, confusion, opthalmoplegia/nystagmus).

Kwashiorkor is found in children, generally under age 4, who suffer from severe protein malnutrition. Symptoms include edema, red hair, muscle wasting, and eventual death.

Pellagra is due to niacin (B3) deficiency and classically presents with the D’s – dermatitis, dementia, and diarrhea.

Rickets is due to a vitamin D deficiency. It classically presents with symptoms/signs of osteomalacia or “softening” of the long bones – bowed legs, “knocked knees,” greenstick fractures, costochondral pain, and especially growth disorders.