A 27-year-old man presented with a 2-month history of headache and orthostatic dizziness. He worked as a manager in a fast-food restaurant, and reported drinking 10 to 15 L of caffeinated soft drink (cola) per day for the past 3 years. He only conceded eating small amounts of solid food every few days. There was a 6-pack-year smoking habit. Easy bruising, gingival bleeding, and recent alopecia were reported.
Clinical examination revealed obesity (body mass index [calculated as weight in kilograms divided by the square of height in meters], 32), orthostatic hypotension, scant hair, and shin bruises. Results from a psychiatric examination were normal. Based on the history and physical examination findings, scurvy was suspected, and blood test results confirmed the diagnosis by disclosing severe vitamin C deficit (0.04 mg/dL [2 μmol/L]; normal values, 0.30-1.50 mg/dL [17-85 μmol/L]). Serum levels of selected vitamins (A, B1, B6, B12, E, and folic acid) and electrolytes, however, were within normal limits. Vitamin supplementation (1 g/d) and dietary counseling were initiated, which allowed resolution of the presenting symptoms within a few days.