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

Written By : Dr.Niharika Harsha B |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-08-12T10:40:34+05:30 | Updated On 13 Aug 2020 5:59 PM IST

A recent case report states that Vitamin C deficiency is more difficult to diagnose in patients with Crohn's Disease (CD) as the symptoms of CD overlap with scurvy. The case was published in the journal 'ACG Case Reports Journal' 2020.

Crohn's disease presents with multi nutritional deficiency and vitamin C deficiency is one of its underdiagnosed deficiency. Vitamin C deficiency is not so frequently diagnosed and reported in spite of its prevalence and being a reversible condition. Benjamin Gordon et al from the Presbyterian/Weill Cornell Medical Center, New York reported a case of long-standing CD who presented with gum bleeding and was found to have scurvy.

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.

vitamin CVitamin C deficiencyCrohn's disease

Source : ACG Case Reports Journal.

Dr.Niharika Harsha B

BDS, MDS

Dr.Niharika Harsha B (BDS,MDS) completed her BDS from Govt Dental College, Hyderabad and MDS from Dr.NTR University of health sciences(Now Kaloji Rao University). She has 4 years of private dental practice and worked for 2 years as Consultant Oral Radiologist at a Dental Imaging Centre in Hyderabad. She worked as Research Assistant and scientific writer in the development of Oral Anti cancer screening device with her seniors. She has a deep intriguing wish in writing highly engaging, captivating and informative medical content for a wider audience. She can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751