SCURVY DUE TO SUICIDAL SELF-STARVATION

A 29-year-old man was admitted to hospital, unconscious and with exten sive bleedings in skin and muscles. For many weeks he had been practic ally starving himself with suicidal intent. Physical examination revea led signs of anaemia and gingivitis with hypertrophy of the tooth bord ers and bleeding gums, as well as bright blood on rectal examination. There were extensive ecchymoses and petechiae, especially in the legs. Some of the body hair was corkscrew-curly. Haemoglobin level was 7.2 g/dl, mean corpuscular volume 93 fl, reticulocyte count 29 parts per t housand. The Rumpel-Leede test was abnormal (60 petechiae/4 cm(2)), as were the vitamin C level (0.026 mg/dl whole blood) and the ascorbic a cid tolerance test. As these findings indicated scurvy, vitamin C was administered, 1 g daily intravenously for 5 days, followed by 500 mg d aily by mouth. Remarkable improvement was apparent as early as 72 hour s after onset of treatment. The endogenous depression, the underlying cause of the suicide attempt, was treated with clomipramine. When the patient was discharged after 13 days his physical and mental state was much improved.