scurvy is a disease that played an important role in history and used to be the number one killer of sailors .
it is still diagnosed in third - world countries because of malnutrition and in epidemic form in refugee camps .
a 35-year - old patient was seen at the emergency department of a level 1 trauma centre with spontaneous bruisings on the lower extremity .
initially , the patient was seen by an orthopaedic surgeon at an outpatient clinic with a painful knee without any preceding trauma .
the procedure was postponed twice . at first , the arthroscopy was cancelled because the patient had the flu .
the second time the orthopaedic surgeon postponed the operation because of extensive bruising on the right leg ( fig .  1 )
moreover , doctors of the internal medicine and dermatology department were consulted to explore the origin of the haematomas .
2 ) and a biopsy was performed . at the time of the current presentation at the emergency department ,
because of the progression of the haematomas to the patients left leg , the surgeon was consulted to rule out an active bleeding focus . 
 figure  1:small bruises on the upper legs . 

the patient was an electrician , currently unemployed because of knee problems . since 10 weeks
the haematomas on his right leg occurred after an episode of flu a month ago ( fig . 
ever since , he had been exhausted , and he had spent the majority of his time in bed .
his dentist proposed to remove the decaying teeth . according to the patient , the bad teeth
apparently , the patients eating regimen only consisted of bread , sometimes with spread , but mostly without any additions . for this eating habit
on physical examination , we encountered a pale patient with haematomas on his upper legs , generally green / blue or yellow coloured .
laboratory tests revealed anaemia with a haemoglobin drop of 2.5 points in 2 weeks ( from 8.6 to 5.7 mmol / l ) .
no surgical cause for the haematomas was found . instead , the diagnosis of a severe vitamin c deficiency (  scurvy ) by malnutrition due to his eating disorder was considered .
after laboratory blood tests were drawn to confirm the diagnosis , vitamin c supplements were started .
it is regrettable that the united east india company ( voc ) lost more sailors on scurvy than on the battlefield during the seventeenth century .
scurvy was one of the limiting factors for travelling long distances on ships because of the absence of fresh food , fruit and vitamins .
scurvy was first described by hippocrates . later in 1753 , a surgeon of the royal navy described how citrus fruits enhanced the symptoms of scurvy . in 1930 , it was discovered that depletion of vitamin c level was the cause .
vitamin c is needed for the synthesis of collagen , which is essential for firmness of the blood vessels . in patients with scurvy ,
the presentation of scurvy is often malaise , fatigue , stiff joints and bruising , mostly on the upper thighs and legs .
the next stage consists of open wounds , jaundice , fever , loss of teeth and finally death .
scurvy does not occur in most animals as they can synthesize their own vitamin c in contrast with the human , for example guinea pigs and certain monkey species .
treatment is relatively simple with a versatile diet with citrus fruits , sweet peppers and tomatoes .
the recommended daily quantity of vitamin c is 75 mg for women and 90 mg for man   ( http://www.who.int/en/ ) , but up to 40% more can be necessary in smokers and during infection .
nowadays , scurvy occurs predominantly in developed countries because of malnutrition , and frequently epidemics are reported from the lesser civilized areas .
this present case report emphasizes that scurvy may still occur in developed countries and that patients with scurvy could be encountered by physicians of multiple medical disciplines .
scurvy should be considered in risk groups , e.g. singles , patients with eating disorder , students , elderly , alcohol abusers and patients after gastric surgery [ 5 , 6 ] .
recently , in wales ( uk ) in 2011 , a young patient died of scurvy ( http://www.bbc.com/news/uk-wales-31039895 ) .
however , even in these modern timeframe , groups with a high risk of vitamin deficiencies can be discerned . in our patient
, the biopsy could have been avoided , and supplements could have been initiated more quickly in case of higher awareness of the signs and symptoms of vitamin c deficiency .
 scurvy is a disease that played an important role in ancient history and used to be a notorious cause of death in sailors . 
 nowadays , scurvy is not a common diagnosis in the civilized world , but this case report indicates that this old - fashioned disease is not extinct at all and still exists but in a different patient category . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONFLICT OF INTEREST STATEMENT