We read with interest the concise communication by Mehta et al on systemic pseudovasculitis from scurvy in anorexia nervosa (1). Scurvy should be considered in the differential diagnosis of vasculitis, particularly in patients who are on unusual diets. The Health and Nutrition Examination Survey (HANES I) revealed that up to 42% of those studied have vitamin C intakes that are less than half the recommended daily allowance, particularly those in the lower socioeconomic stratum (2). In 1994, our group described 3 patients referred to our rheumatology service for "vasculitis" who were found to have scurvy (3). The patients were on idiosyncratic diets low in or void of vitamin C, and they presented with a purpuric rash, myalgias, arthralgias, and malaise. A perifollicular distribution of petechiae made us suspect scurvy. Serum vitamin C determinations and skin biopsies led to this diagnosis. The following year, we saw another patient with pseudovasculitis of the same cause.
Rheumatology textbooks do not mention scurvy as an imitator of vasculitis. This is an important oversight. With the increasing popularity of fad diets, it is incumbent upon us to obtain a careful dietary history from patients who present with apparent features of vasculitis. Scurvy is curable, and treatments used for vasculitis can be toxic and should certainly be avoided in patients who do not have the disease.