Scurvy presenting as lower limb ecchymoses in the setting of metastatic colorectal cancer

• Published in: BMJ case reports 2020-12, Vol.13 (12), p.e237507
• Main Authors: Inglis, Joshua M, Tan, Jia
• Format: Article
• Language: English
• Subjects: Abdomen; Alcohol use; Anemia; Ankle; Antibiotics; Antineoplastic Agents, Immunological - therapeutic use; Ascorbic Acid - administration & dosage; Ascorbic Acid - blood; Bacteremia - diagnosis; Bacteremia - microbiology; Biopsy; Blood; Blood platelets; Case Report; Case reports; Chemotherapy; Colectomy - adverse effects; Colectomy - methods; Collagen; colon cancer; Colorectal cancer; Colorectal Neoplasms - pathology; Colorectal Neoplasms - physiopathology; Colorectal Neoplasms - secondary; Colorectal Neoplasms - therapy; Diagnosis, Differential; Ecchymosis - blood; Ecchymosis - diagnosis; Ecchymosis - etiology; Edema; Female; gastrointestinal surgery; Hematology; Humans; Klebsiella - isolation & purification; Lower Extremity; malnutrition; Malnutrition - etiology; Malnutrition - therapy; Metastasis; Middle Aged; Monoclonal antibodies; Neoplasm Metastasis; Neoplasm Staging; Neutrophils; nutritional support; Nutritional Support - methods; Ostomy; Pelvic Exenteration - adverse effects; Pelvic Exenteration - methods; Plastic surgery; Proteins; Purpura; Scurvy - blood; Scurvy - etiology; Scurvy - physiopathology; Scurvy - therapy; Skin & tissue grafts; Skin - pathology; Targeted cancer therapy; Thrombosis; Treatment Outcome; Ultrasonic imaging; Vitamin C; Vitamins - administration & dosage
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-237507

A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have Klebsiella bacteraemia secondary to urinary source. Skin biopsy showed dermal haemorrhage without vessel inflammation. Vitamin C levels were low confirming the diagnosis of scurvy.