Overlooked and Undernourished: A Case Report of Scurvy Linked to Food Insecurity

Food insecurity is a commonly underrecognized social determinant of health and is a risk factor for severe, though uncommon, nutritional deficiencies. This report describes a 60-year-old male with a history of asthma and housing instability who presented to the emergency department (ED) for shortness of breath and was found to have classic findings of vitamin C deficiency, colloquially known as scurvy. Examination revealed diffuse wheezing, poor dentition with palatal ecchymosis, and a perifollicular rash with scattered bruising on his bilateral lower extremities. Due to financial struggles, he was experiencing food and housing insecurity, with a diet primarily composed of processed carbohydrates. Laboratory studies revealed anemia, hypoalbuminemia, and severely low levels of vitamins C and B6. He was admitted for management of his asthma exacerbation and treatment of his nutritional deficiencies with vitamin supplementation, electrolyte repletion, and dietary support. Upon discharge, he was placed in a nearby shelter with financially accessible follow-up care, food bank resources, and multivitamin prescriptions. At follow-up three weeks later, his dermatologic findings had resolved. This case highlights the importance of a thorough physical examination and detailed social history in the ED to avoid missing subtle yet clinically significant diagnoses. It underscores the need for early recognition and treatment of nutritional deficiencies, particularly in vulnerable populations. Furthermore, it demonstrates the value of accessible follow-up care in supporting the management of nutritional deficiencies and promoting long-term recovery. Topics: Scurvy, vitamin C deficiency, nutritional deficiency, nutritional insecurity, food insecurity.