PT  - JOURNAL ARTICLE
AU  - Francesco Fiorini
AU  - Louise Braddick
AU  - Hasnain Hashim
AU  - Robert M Ayto
AU  - Alana Jacobs
AU  - Yetunde Baoku
AU  - Shahir S Hamdulay
TI  - Lesson of the month 1: Massive spontaneous haematomas in an elderly man
AID  - 10.7861/clinmedicine.18-2-180
DP  - 2018 Apr 01
TA  - Clinical Medicine
PG  - 180--182
VI  - 18
IP  - 2
4099  - http://www.rcpjournals.org/content/18/2/180.short
4100  - http://www.rcpjournals.org/content/18/2/180.full
SO  - Clin Med2018 Apr 01; 18
AB  - A 73-year-old man presented with bilateral leg pain and swelling, and no history of trauma or bleeding disorders. Clinical examination, biochemistry and magnetic resonance imaging of the thighs were suggestive of muscle haematomas. These progressed significantly during the admission, requiring blood transfusion. Normal vascular anatomy on computed tomography, renal and liver function, and absence of infection made a bleeding diathesis more likely. This may be caused by coagulation defects, platelet disorders and vascular fragility. An undetectable serum ascorbic acid level confirmed the clinical suspicion of scurvy, and administration of vitamin C resulted in rapid improvement. Our case provides a structured approach to the diagnosis of bleeding disorders and scurvy, a treatable and potentially fatal disease which is often forgotten.