RT Journal Article SR Electronic T1 Lesson of the month 1: Massive spontaneous haematomas in an elderly man JF Clinical Medicine JO Clin Med FD Royal College of Physicians SP 180 OP 182 DO 10.7861/clinmedicine.18-2-180 VO 18 IS 2 A1 Francesco Fiorini A1 Louise Braddick A1 Hasnain Hashim A1 Robert M Ayto A1 Alana Jacobs A1 Yetunde Baoku A1 Shahir S Hamdulay YR 2018 UL http://www.rcpjournals.org/content/18/2/180.abstract 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.