Crohn's Disease may mask Vitamin C deficiency symptoms: Case report

The case in question was a 58-year-old woman who presented to the clinic with complaint of gum bleeding for several months. She had a 47-year history of stricturing ileocolonic Crohn's disease which was in remission after remote ileocolonic resection. She also had Hashimoto's thyroiditis, and quiescent Sjogren syndrome. She did not give any h/o gastrointestinal or obstructive symptoms and was on low-residue, low-fermentable oligo-, di-, mono-saccharides and polyols diet. Her medical history revealed cholestyramine 4 g twice daily for bile acid diarrhea and mesalamine 250 mg 4 times daily. Her Harvey-Bradshaw index was 5 which was notable for mild abdominal pain and had 3 loose stools a day. Her previous colonoscopy showed total aggregate simple endoscopic score of 4, with <0.5 cm aphthous ulcers in the ileum and benign-appearing moderate stenosis.

Physical examination revealed gingival swelling and bleeding, and slightly distended abdomen. Laboratory data were all within normal limits except for Vitamin C level which was < 5 μmol/L. Patient was prescribed 100 mg ascorbic acid 3 times and in a few weeks her symptoms resolved.

This case highlights the importance of appreciating vitamin C deficiency in patients with CD considering the marked morbidity and complications of Crohn's Disease.

The case 'Vitamin C Deficiency: An Under-Recognized Condition in Crohn's Disease' was published in ACG Case Reports Journal.