avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2017-7-3-228-232avk-659Research ArticleРАЗБОР КЛИНИЧЕСКИХ СЛУЧАЕВANALYSIS OF CLINICAL CASESЦИНГА — ЗАБЫТОЕ ЗАБОЛЕВАНИЕ ПОД МАСКОЙ ГЕМОРРАГИЧЕСКОГО ВАСКУЛИТАSCURVY — A FORGOTTEN DISEASE UNDER THE GUISE OF HEMORRHAGIC VASCULITISЧипигинаН. С.ChipiginaN. S.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruКарповаН. Ю.KarpovaN. Yu.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruБольшаковаМ. А.BolshakovaM. A.chipigina-natalia56@yandex.ruКалининаТ. Ю.KalininaT. Y.chipigina-natalia56@yandex.ruАсхабоваЭ. Д.AskhabovaE. D.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruЮзашароваЛ. М.YuzakharovaL. M.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruБагманянС. Д.BagmanyanS. D.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruБадалянК. А.BadalyanK. A.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruЮцевичО. К.YutsevichO. K.

Кафедра факультетской терапии им. академика А.И. Нестерова

Chair of faculty therapy named after academician A.I. Nesterov

chipigina-natalia56@yandex.ruФГБОУ ВО Российский Национальный Исследовательский Университет имени Н.И. Пирогова, МоскваРоссияRussian National Research Medical University named after N.I. Pirogov, MoascowRussian FederationГБУЗ «ОКД № 1 ДЗМ», МоскваРоссия«Oncological Cliniсal Dispensary № 1 Department of Public Health of Moscow», MoscowRussian Federation20172805201773228232Copyright © Чипигина Н.С., Карпова Н.Ю., Большакова М.А., Калинина Т.Ю., Асхабова Э.Д., Юзашарова Л.М., Багманян С.Д., Бадалян К.А., Юцевич О.К., 20172017Чипигина Н.С., Карпова Н.Ю., Большакова М.А., Калинина Т.Ю., Асхабова Э.Д., Юзашарова Л.М., Багманян С.Д., Бадалян К.А., Юцевич О.К.Chipigina N.S., Karpova N.Y., Bolshakova M.A., Kalinina T.Y., Askhabova E.D., Yuzakharova L.M., Bagmanyan S.D., Badalyan K.A., Yutsevich O.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/659Введение

Введение. Цинга очень редко диагностируется в современных условиях. Материал и методы. Мы наблюдали случай цинги, возникший в результате длительного неполноценного питания у ранее здорового 50-летнего мужчины с низким доходом. Результаты. Заболевание проявлялось сильной слабостью, отеками ног, гингивитом и спонтанными геморрагическими высыпаниями на ногах, которые первоначально были расценены как геморрагический васкулит. Сливной характер геморрагических высыпаний, их преимущественная локализация по задней поверхности бедер и голеней, наличие перифолликулярных геморрагий, патогномоничных для цинги, гингивит, полное отсутствие в питании аскорбиновой кислоты в течение нескольких месяцев, а также сопутствующая алиментарная дистрофия и поливитаминная недостаточность позволили заподозрить у больного цингу. Быстрый эффект лечения витамином С подтвердил этот диагноз. Выводы. Дифференциальный диагноз спонтанных геморрагических высыпаний и пурпуры у больных с длительным неполноценным питанием должен включать цингу — почти забытое в современных условиях заболевание.

 

 

Background

Background. Scurvy is very rarely seen in modern conditions. Material and Methods. We observed a case of scurvy that occurred as a result of prolonged malnutrition in a previously healthy 50-year-old man with low income. Results. The disease was manifested by severe weakness, edema of the legs, gingivitis and spontaneous hemorrhagic eruptions on the legs, which were initially regarded as hemorrhagic vasculitis. The confluent character of hemorrhagic eruptions, their predominant localization along the posterior surface of the legs, the presence of perifollicular hemorrhages, pathognomonic for scurvy, gingivitis, complete absence of ascorbic acid consumption for several months, as well as concomitant alimentary dystrophy and multivitamin deficiency, allowed us to suspect scurvy in the patient. The rapid effect of vitamin C treatment has confirmed this diagnosis. Conclusions. The differential diagnosis of spontaneous hemorrhagic eruptions and purpura in patients with prolonged malnutrition should include scurvy, a disease almost forgotten in modern conditions.

 

 

цингадефицит витамина Сгеморрагические высыпанияscurvyscorbutvitamin C deficiencyhemorrhagic eruptionsReferencesВерн Ж. Путешествие и приключения капитана Гаттераса. Перевод с французского. Пущино: Культура. 1993; 366 с. Verne J. The Adventures of Captain Hatteras. Translation from French. Pushchino: Culture. 1993; 366 p. [in Russian].Верн Ж. Путешествие и приключения капитана Гаттераса. Перевод с французского. Пущино: Культура. 1993; 366 с. Verne J. The Adventures of Captain Hatteras. Translation from French. Pushchino: Culture. 1993; 366 p. [in Russian].Smith A., Di Primio G., Humphrey-Murto S. Scurvy in the developed world CMAJ. 2011 Aug 9; 183(11).Smith A., Di Primio G., Humphrey-Murto S. Scurvy in the developed world CMAJ. 2011 Aug 9; 183(11).Schleicher R.L., Carroll M.D., Ford E.S. et al. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003–2004 National Health and Nutrition Examination Survey (NHANES). Am. J. Clin. Nutr. 2009; 90: 1252–1263.Schleicher R.L., Carroll M.D., Ford E.S. et al. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003–2004 National Health and Nutrition Examination Survey (NHANES). Am. J. Clin. Nutr. 2009; 90: 1252–1263.Nishida M., Grossi S.G., Dunford R.G., Ho A.W., Trevisan M., Genco R.J. Dietary vitamin C and the risk for periodontal disease. J. Periodontol. 2000; 71: 1215–1223.Nishida M., Grossi S.G., Dunford R.G., Ho A.W., Trevisan M., Genco R.J. Dietary vitamin C and the risk for periodontal disease. J. Periodontol. 2000; 71: 1215–1223.Touyz L.Z. Vitamin C, oral scurvy and periodontal disease. S. Afr. Med. J. 1984; 65: 838–842.Touyz L.Z. Vitamin C, oral scurvy and periodontal disease. S. Afr. Med. J. 1984; 65: 838–842.Hirschmann J.V., Raugi G.J. Adult scurvy. J. Am. Acad. Dermato. 1999; 41: 895–906.Hirschmann J.V., Raugi G.J. Adult scurvy. J. Am. Acad. Dermato. 1999; 41: 895–906.Fain O. Musculoskeletal manifestations of scurvy. Joint Bone Spine 2005; 72: 124–128Fain O. Musculoskeletal manifestations of scurvy. Joint Bone Spine 2005; 72: 124–128Omeldo J., Yiannias J.A., Windgassen E.B., Gornet M.K. Scurvy: a disease almost forgotten. Int. J. Dermatol. 2006; 45: 909–913.Omeldo J., Yiannias J.A., Windgassen E.B., Gornet M.K. Scurvy: a disease almost forgotten. Int. J. Dermatol. 2006; 45: 909–913.Pangan A.L., Robinson D. Hemarthrosis as initial presentation of scurvy. J. Rheumatol. 2001; 28: 1923–1925.Pangan A.L., Robinson D. Hemarthrosis as initial presentation of scurvy. J. Rheumatol. 2001; 28: 1923–1925.Bartholomew M. James. Lind’s Treatise of the Scurvy (1753) Postgrad Med. J. 2002; 78: 695–696.Bartholomew M. James. Lind’s Treatise of the Scurvy (1753) Postgrad Med. J. 2002; 78: 695–696.Fain O., Mathieu E., Thomas M. Scurvy in patients with cancer. Br. Med. J. 1998; 316(7145): 1661–1662.Fain O., Mathieu E., Thomas M. Scurvy in patients with cancer. Br. Med. J. 1998; 316(7145): 1661–1662.De Luna R.H., Colley B.J., 3rd, Smith K., Divers S.G., Rinehart J., Marques M.B. Scurvy: an often forgotten cause of bleeding. Am. J. Hematol. 2003; 73(1): 85–87.De Luna R.H., Colley B.J., 3rd, Smith K., Divers S.G., Rinehart J., Marques M.B. Scurvy: an often forgotten cause of bleeding. Am. J. Hematol. 2003; 73(1): 85–87.Des Roches A., Paradis L., Paradis S., Singer S. Food allergy as a new risk factor for scurvy. Allergy. 2006; 61(12): 1487–1488.Des Roches A., Paradis L., Paradis S., Singer S. Food allergy as a new risk factor for scurvy. Allergy. 2006; 61(12): 1487–1488.Chambial S., Dwivedi S., Shukla K.K., John P.J., Scharma P. Vitamin C in disease prevention and cure: an overview. Indian J. Clin. Biochem. 2013; 28: 314–328.Chambial S., Dwivedi S., Shukla K.K., John P.J., Scharma P. Vitamin C in disease prevention and cure: an overview. Indian J. Clin. Biochem. 2013; 28: 314–328.Padayatty S.J., Levine M. New insights into the physiology and pharmacology of vitamin C. Can. Med. Assoc. J. 2001; 164(3): 353–355.Padayatty S.J., Levine M. New insights into the physiology and pharmacology of vitamin C. Can. Med. Assoc. J. 2001; 164(3): 353–355.Pimentel L. Scurvy: historical review and current diagnostic approach. Am. J. Emerg. Med. 2003; 21: 328–332.Pimentel L. Scurvy: historical review and current diagnostic approach. Am. J. Emerg. Med. 2003; 21: 328–332.Ревматология: учебное пособие. Под редакцией проф. Н.А. Шостак. М.ГЭОТАР-Медиа. 2012; 448 с. Rheumatology: a study guide. Edited by prof. N.A. Shostak. M. GEOTAR-Media, 2012; 448 p. [in Russian].Ревматология: учебное пособие. Под редакцией проф. Н.А. Шостак. М.ГЭОТАР-Медиа. 2012; 448 с. Rheumatology: a study guide. Edited by prof. N.A. Shostak. M. GEOTAR-Media, 2012; 448 p. [in Russian].Ozen S., Pistorio A., Lusan S.M. et al. Paediatric rheumatology international trials organization (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarthritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.Ozen S., Pistorio A., Lusan S.M. et al. Paediatric rheumatology international trials organization (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarthritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.Fossitt D.D., Kowalski T.J. Classic skin findings of scurvy. Mayo Clin. Proc. 2014 Jul; 89(7): e61.Fossitt D.D., Kowalski T.J. Classic skin findings of scurvy. Mayo Clin. Proc. 2014 Jul; 89(7): e61.Fain O., Pariés J., Jacquart B. et al. Hypovitaminosis C in hospitalized patients. Eur. J. Intern. Med. 2003; 14(7): 419–425.Fain O., Pariés J., Jacquart B. et al. Hypovitaminosis C in hospitalized patients. Eur. J. Intern. Med. 2003; 14(7): 419–425.Hampl J.S., Taylor C.A., Johnston C.S. Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994. Am. J. Public. Health. 2004 ;94(5): 870–875.Hampl J.S., Taylor C.A., Johnston C.S. Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994. Am. J. Public. Health. 2004 ;94(5): 870–875.Raynaud-Simon A., Cohen-Bittan J., Gouronnec A. et al. Scurvy in hospitalized elderly patients. J. Nutr. Health. Aging. 2010 Jun; 14(6): 407-410.Raynaud-Simon A., Cohen-Bittan J., Gouronnec A. et al. Scurvy in hospitalized elderly patients. J. Nutr. Health. Aging. 2010 Jun; 14(6): 407-410.Velandia B., Centor R.M., McConnell V. et al. Scurvy is still present in developed countries. .J Gen. Intern. Med. 2008; 23: 1281–1284.Velandia B., Centor R.M., McConnell V. et al. Scurvy is still present in developed countries. .J Gen. Intern. Med. 2008; 23: 1281–1284.Ohta A., Yoshida S., Imaeda H. et al. Scurvy with gastrointestinal bleeding Endoscopy 2013; 45(S 02): E147-E148.Ohta A., Yoshida S., Imaeda H. et al. Scurvy with gastrointestinal bleeding Endoscopy 2013; 45(S 02): E147-E148.Shaath T., Fischer R., Goeser M., Rajpara A., Aires D. Scurvy in the present times: vitamin c allergy leading to strict fast food diet. Dermatol. Online J. 2016 Jan 15; 22(1).Shaath T., Fischer R., Goeser M., Rajpara A., Aires D. Scurvy in the present times: vitamin c allergy leading to strict fast food diet. Dermatol. Online J. 2016 Jan 15; 22(1).Levavasseur M., Becquart C., Pape E. et al. Severe scurvy: an underestimated disease. Eur. J. Clin. Nutr. 2015 Sep; 69(9): 1076-1077.Levavasseur M., Becquart C., Pape E. et al. Severe scurvy: an underestimated disease. Eur. J. Clin. Nutr. 2015 Sep; 69(9): 1076-1077.Vairo G., Salustri A., Trambaiolo P., D’Amore F. Scurvy mimicking systemic vasculitis. Minerva Med. 2002 Apr; 93(2): 145-150.Vairo G., Salustri A., Trambaiolo P., D’Amore F. Scurvy mimicking systemic vasculitis. Minerva Med. 2002 Apr; 93(2): 145-150.Tamura Y., Welch D.C., Zic J.A., Cooper W.O., Stein S.M., Hummell D.S. Scurvy presenting as painful gait with bruising in a young boy. Arch. Pediatr. Adolesc. Med. 2000; 154(7): 732–735.Tamura Y., Welch D.C., Zic J.A., Cooper W.O., Stein S.M., Hummell D.S. Scurvy presenting as painful gait with bruising in a young boy. Arch. Pediatr. Adolesc. Med. 2000; 154(7): 732–735.

The authors declare that there are no conflicts of interest present.