Possible rewritten content:
Severe Vitamin C Deficiency (Scurvy): A Diagnosis That Highlights the Need for Better Medical Education and Patient Care for Individuals with Disabilities
A 24-year-old man sought HIV preexposure prophylaxis (PrEP) from the Infectious Disease (ID) clinic due to his sexual activity with women, including a recent encounter with a trans woman commercial sex worker. Apart from occasional condom use and no STIs, he reported several months of severe fatigue, non-healing skin ulcers, and difficult bowel movements requiring manual disimpaction, but no rectal bleeding. While on PrEP, he had a complete blood count (CBC) due to the persistent fatigue, which revealed microcytic anemia, low hemoglobin, high platelet count, and a mean corpuscular volume (MCV) that suggested iron deficiency anemia. Follow-up labs justified IV iron therapy, but the skin ulcers remained unchanged. Further evaluations by experts in hematology and gastroenterology led to the discovery that the patient had a severe Vitamin C deficiency (scurvy) necessitating ascorbate supplementation and dietary modification.
The patient had a history of T1 paraplegia, neurogenic bowel and bladder, previous surgeries, wheelchair use, and limited access to ascorbate-rich foods. Vitamin C deficiency can impair collagen synthesis, wound healing, and iron absorption, which may result in anemia, fatigue, and skin ulcers similar to those experienced by this patient. While his disability and other comorbidities could predispose him to scurvy, delays or oversights in clinical observation and patient care could also miss the diagnosis, exacerbate the patient’s symptoms, or incite costly and unnecessary workups. Empiric antibiotic treatment for suspected infections, such as the use of doxycycline, can further complicate wound healing in patients with ascorbate deficiency by hindering collagen cross-linking.
The case report emphasizes the need for better medical education and patient care for individuals with disabilities, who still face unequal treatment due to misconceptions about their quality of life, lack of awareness, and cultural competence. According to estimates, 26% of US adults live with a disability, which underscores the importance of recognizing disability-friendly healthcare practices, integrating collective and holistic clinical approaches, and promptly addressing patients’ concerns. In this case, prompt diagnosis and coordinated interventions helped the patient’s skin ulcers to heal entirely and resolved his anemia and fatigue, as confirmed by follow-up labs. The patient and clinician agreed to retain Vitamin C and iron supplementation as part of his daily regimen.
Scurvy, a treatable condition, exemplifies the significance of clinical risk factors, social and cultural awareness, and collaborative interdisciplinary approaches to patient care. By increasing awareness, education, and implementation of best practices, healthcare professionals can improve the diagnosis, treatment, and follow-up of scurvy and other similar conditions, particularly in patients with disabilities.
