A teenager with severe anorexia nervosa developed scurvy, a disease caused by not getting enough vitamin C. She came to the hospital with a strange rash, stomach pain, and signs of severe malnutrition. Doctors initially thought she had a serious infection, but blood tests and imaging showed something different. A skin biopsy revealed she had scurvy, which is rare today but serious. She recovered quickly after receiving vitamin C treatment and nutritional support. This case shows why doctors need to ask about eating habits and look carefully at patients who are severely malnourished.

The Quick Take

  • What they studied: How scurvy (a disease from not eating enough vitamin C) showed up in an 18-year-old girl with a severe eating disorder, and how doctors figured out what was wrong
  • Who participated: One 18-year-old female patient with severe anorexia nervosa (an eating disorder where people eat very little) who weighed only 37.9 kilograms (about 84 pounds)
  • Key finding: The patient had scurvy caused by severe malnutrition from her eating disorder. She developed an unusual rash instead of the typical gum problems doctors usually see with scurvy. Vitamin C treatment cleared up her rash within one week
  • What it means for you: This case reminds doctors to think about vitamin deficiencies in severely malnourished patients and to ask about eating habits. If you or someone you know has an eating disorder, getting proper nutrition is critical to prevent serious health problems like this

The Research Details

This is a case report, which means doctors are describing what happened with one specific patient. The 18-year-old girl came to the hospital very sick and malnourished. Doctors did many tests to figure out what was causing her rash and other symptoms, including blood work, imaging scans, cultures to check for infections, and a small skin biopsy (a tiny sample of skin examined under a microscope).

The doctors initially thought she might have a serious abdominal infection and started her on antibiotics. However, when all the infection tests came back normal and imaging showed nothing wrong, they looked more carefully at her symptoms and her severe malnutrition. The skin biopsy was the key test that confirmed scurvy by showing bleeding under the skin without signs of infection or blood vessel disease.

After diagnosis, she received vitamin C treatment through an IV (intravenous line) and nutritional support through a feeding tube. Doctors tracked how quickly her rash improved to confirm the diagnosis was correct.

This research approach is important because scurvy is so rare in developed countries that doctors might not think of it first. By carefully documenting this case, doctors can learn to recognize unusual presentations of scurvy and think about vitamin deficiencies in severely malnourished patients. This helps other doctors make faster diagnoses and start treatment sooner

This is a single case report, which is the lowest level of scientific evidence. However, it’s valuable because it documents an unusual presentation of a disease. The diagnosis was confirmed with a skin biopsy, which is reliable. The patient’s rapid improvement after vitamin C treatment strongly supports the diagnosis. Readers should understand this describes one patient’s experience and cannot be generalized to all people with eating disorders

What the Results Show

The patient presented with a widespread rash covering her stomach area, forearms, and shins that didn’t blanch (turn white) when pressed. She also had stomach pain, reduced urination, and appeared severely malnourished and dehydrated. Physical examination showed signs typical of severe eating disorders including very pale skin, fine body hair (lanugo), dry skin, angular mouth sores, thin hair, and calluses on her knuckles from self-induced vomiting.

Blood tests were mostly normal except for mild kidney problems and very low phosphate levels. All tests for infection came back negative, including throat swabs, blood cultures, and urine cultures. Imaging scans of her abdomen and urinary tract showed nothing abnormal. The skin biopsy was the breakthrough finding—it showed bleeding throughout the skin layers without any signs of infection or blood vessel inflammation, confirming scurvy.

Treatment with intravenous vitamin C (500 milligrams per dose) produced dramatic improvement. The rash resolved almost completely within one week. She also received nutritional support through a feeding tube and phosphate replacement to prevent refeeding complications.

The patient showed multiple physical signs of severe malnutrition beyond the rash. She had corkscrew-shaped hairs and bleeding around hair follicles on her shins, which are classic signs of vitamin C deficiency. Her extremely low body weight (BMI of 13, which is critically low) and dehydration indicated severe nutritional crisis. The mild kidney problems and severe low phosphate levels suggested her body was in distress from prolonged malnutrition

Scurvy is historically known as a disease of sailors and people without access to fresh fruits and vegetables. It typically causes bleeding gums, loose teeth, and poor wound healing. This case is unusual because the patient didn’t have the classic gum bleeding—instead, she presented with a rash. This atypical presentation could cause doctors to miss the diagnosis if they’re only looking for typical signs. The case highlights that severe eating disorders can cause the same nutritional deficiencies as historical food scarcity

This is a single case report involving one patient, so the findings cannot be applied to all people with eating disorders or all cases of scurvy. We don’t know if other patients with similar eating disorders would present the same way. The case doesn’t tell us how common this presentation is or whether certain factors made this patient more likely to develop scurvy. Additionally, we don’t have long-term follow-up information about whether the patient’s rash stayed away or if she recovered fully from her eating disorder

The Bottom Line

Healthcare providers should consider vitamin C deficiency in severely malnourished patients presenting with unexplained rashes, even if they don’t have typical scurvy signs. People with eating disorders should receive comprehensive nutritional assessment and supplementation. If you have an eating disorder, seek professional help immediately—severe malnutrition can cause life-threatening complications. (Confidence: High for clinical recognition; Moderate for general population application)

This case is most relevant to doctors, nurses, and other healthcare providers treating patients with eating disorders or severe malnutrition. It’s also important for people with eating disorders and their families to understand how serious nutritional deficiencies can become. Mental health professionals treating eating disorders should be aware of these physical complications. General readers should understand that eating disorders have serious physical consequences beyond weight loss

In this case, vitamin C treatment produced visible improvement within one week. However, full recovery from scurvy and from an eating disorder takes much longer. Eating disorders require long-term treatment including mental health support, nutritional rehabilitation, and medical monitoring. Recovery is possible but requires professional help and commitment

Want to Apply This Research?

  • For users with eating disorders or at-risk populations: Track daily fruit and vegetable intake (aiming for 5+ servings daily) and monitor for unusual bruising, rashes, or bleeding gums. Log these observations weekly to share with healthcare providers
  • If using a nutrition tracking app: Set daily reminders to eat vitamin C-rich foods (oranges, strawberries, bell peppers, broccoli). Create a simple checklist of these foods to include in meals. If you notice unusual bruising or rashes, flag this in the app to discuss with your doctor
  • Users should track: (1) Daily vitamin C intake from food sources, (2) Any unusual bruising or skin changes, (3) Energy levels and physical symptoms, (4) Adherence to medical appointments. Share monthly summaries with healthcare providers to catch nutritional deficiencies early

This case report describes one patient’s experience with scurvy related to severe anorexia nervosa. It is not medical advice and should not be used for self-diagnosis. Scurvy is a serious medical condition requiring professional diagnosis and treatment. If you have symptoms of vitamin deficiency (unusual bruising, rashes, bleeding gums, weakness) or struggle with an eating disorder, please contact a healthcare provider immediately. Eating disorders are serious mental health conditions that require professional treatment. If you or someone you know is struggling with an eating disorder, contact the National Eating Disorders Association (NEDA) helpline at 1-800-931-2237 or text ‘NEDA’ to 741741. This information is for educational purposes only and does not replace professional medical advice.