Pseudovasculitic Scurvy Mimicking Small Vessel Vasculitis: A Case Report

Background and clinical significance: Scurvy, resulting from vitamin C deficiency, is rare in the 21st century, particularly in high-income settings. Its nonspecific presentation and ability to mimic a wide range of conditions make diagnosis incredibly challenging. Pseudovasculitic petechial lesions of the lower limbs may be misdiagnosed as systemic vasculitis, often leading to extensive investigations and delayed treatment. Case presentation: We report the case of a 45-year-old woman who presented with progressive lower limb pain, swelling, and vasculitis-like petechial rash with ecchymoses. Extensive investigations for autoimmune, infectious, malignant, and vascular causes, including skin biopsy, were unremarkable. A detailed dietary history revealed markedly restrictive intake. Characteristic dermatological findings, including perifollicular haemorrhage, ecchymoses and hair shaft abnormalities, raised suspicion for scurvy. Profoundly reduced serum ascorbic acid levels confirmed vitamin C deficiency. Conclusions: This case highlights the importance of thorough dietary assessment, recognition of characteristic cutaneous features, and identification of risk factors such as restrictive eating patterns or chronic gastrointestinal symptoms. It underscores the need for a high index of clinical suspicion for scurvy, even in contemporary high-income settings. Early diagnosis and vitamin C supplementation can result in rapid clinical improvement and prevent avoidable morbidity.