A 37-year-old woman’s bruising from a massage gun ended up having a cause stranger than anyone could have expected. In a recent report, doctors documented how the woman had developed the rare condition scurvy.
Doctors at the University of Pennsylvania detailed the bizarre turn of events in a paper published last month in the New England Journal of Medicine as part of a regular segment highlighting medically complex cases. The woman’s bruising was the only first sign of worsening health issues that eventually landed her in the hospital. Fortunately, after several false leads, her clinicians correctly diagnosed the woman’s vitamin C deficiency, and she made a full recovery.
“The current case serves as a reminder that scurvy continues to occur in the United States…”
The wrong culprit
According to the report, the woman visited the emergency room four days into having acute pain, swelling, and bruising on the upper portion of her left knee—symptoms that began after she used an electric massage gun on that area. She carried a genetic mutation that increased her general risk of blood clotting, which was managed with a blood thinner, and also had a long history of heavy menstrual bleeding. Anyone can potentially bruise or hurt themselves by applying too much pressure with a massage gun, though, and since initial tests didn’t find any other underlying reason for her symptoms, she was discharged and simply told to stop using the gun.
Several weeks later, however, she visited the ER again, now with new symptoms of lightheadedness and shortness of breath while exerting herself. She was then admitted to the hospital. The doctors suspected she had anemia caused by a lack of iron, and she was discharged with a prescription for iron pills and weekly IV infusions of iron.
Despite her treatment, her anemia and overall health continued to worsen, however. She visited the ER once more six weeks after her hospitalization with new chest pain, night sweats, and a sudden weight loss of 15 pounds. She now also had a high heart rate and low blood oxygen level, and soon enough, she was admitted to the intensive care unit.
Doctors determined she had developed pulmonary hypertension, a life-threatening type of high blood pressure that affects the arteries in the lungs and right side of the heart. But all of their tests continued to show no clear indication of what was causing her illness in the first place.
Throughout all of this, her left leg continued to show bruising and swelling. And when doctors reexamined both legs, they found distinctive discolored spots and hairs curled up into a corkscrew shape. They also found she had developed “red-purple soft nodules” along her gums. Unlike her earlier, more general symptoms, these skin problems finally pointed to a very specific, if now rarely encountered, culprit: scurvy.
When questioned, the woman admitted that she had purposefully avoided eating anything containing citrus fruits years ago, following an episode of hives that she attributed to eating citrus. Testing failed to detect any vitamin C in her system, and she was immediately started on supplementation.
Just two days into her new therapy, she was discharged from the ICU and eventually the hospital as well. Her health continued to steadily improve over the next few months, and follow-up testing showed that her heart issues had cleared up.
Rare but still around
Thanks to the widespread knowledge that we need regular doses of vitamin C from our diets, scurvy is no longer the fearsome threat it was centuries ago.
But even today, doctors do still occasionally see it. Some research has also suggested that the incidence of scurvy in the U.S. has climbed lately, particularly among vulnerable groups like children with sensory issues, elderly people, and others struggling to eat or afford healthy fruits and vegetables.
This case was stranger than most, though, since pulmonary hypertension usually isn’t linked to scurvy. The authors note that the condition is often hard to diagnose at first because—as is with this case—the earliest signs tend to be non-specific symptoms potentially caused by many different things. So as rare as it is, the doctors hope their report can provide doctors a timely lesson that scurvy is still around.
“The current case serves as a reminder that scurvy continues to occur in the United States and highlights its potential severity and clinical features,” they wrote.