key: cord-0850448-ly08wv68
authors: Richard, Nicolas; Demangeat, Thomas; Grigioni, Sébastien; Achamrah, Najate; Lvovschi, Virginie Eve
title: “Please lower your mask”: A hard diagnosis in COVID‐19 times
date: 2022-03-14
journal: J Am Coll Emerg Physicians Open
DOI: 10.1002/emp2.12692
sha: 6aa4fbf732071f974043a2db495915ca35d88878
doc_id: 850448
cord_uid: ly08wv68

nan

A 64-year-old woman presented to the emergency department (ED) with a painful left ankle after an eversion ankle sprain. The patient wore a surgical mask according to hospital policy. She was a smoker and socially isolated and reported excessive alcohol consumption. First clinical examination found splinter hemorrhage and non-palpable purpura of petechiae of the lower limbs ( Figure 1 ). Laboratory tests were notable for raised aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltransferase, and mean corpuscular volume without anemia, but with folate deficiency. The physician removed her surgical mask during a second examination, revealing many loose teeth ( Figure 2 ).

A diagnosis of scurvy was suspected. Oral high-dose vitamin C supplements (ie, 1 g/day for 2 weeks) were given immediately, before diagnosis confirmation by vitamin C plasma levels (< 3 µmol/L; reference range, 26.1-84.6 µmol/L). Complete biological recovery was achieved after 1 more month of 500 mg/day of vitamin C supplements.

The prevalence of vitamin C deficiency is estimated at 7.1% in the United States 1 and is more frequent in patients with alcohol use

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. 

Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003-2004 National Health and Nutrition Examination Survey (NHANES)

Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders

Scorbut atypique associé à une anorexie mentale

Please lower your mask": A hard diagnosis in COVID-19 times

The authors are grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for her help in editing the manuscript.