TY - JOUR T1 - Lesson of the month 1: Massive spontaneous haematomas in an elderly man JF - Clinical Medicine JO - Clin Med SP - 180 LP - 182 DO - 10.7861/clinmedicine.18-2-180 VL - 18 IS - 2 AU - Francesco Fiorini AU - Louise Braddick AU - Hasnain Hashim AU - Robert M Ayto AU - Alana Jacobs AU - Yetunde Baoku AU - Shahir S Hamdulay Y1 - 2018/04/01 UR - http://www.rcpjournals.org/content/18/2/180.abstract N2 - 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. ER -