{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T03:28:52Z","timestamp":1790479732244,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Vitamin C (ascorbic acid) is an essential water\u2010soluble antioxidant, and deficiency (ie, plasma level &lt;11 \u03bcmol\/L) can result in scurvy. People at the highest risk for vitamin C deficiency (ie, scurvy) are those with inadequate intake, such as patients with alcohol abuse disorder, malnutrition, psychiatric disorders, restrictive eating habits, and food insecurity, as well as those with malabsorptive syndromes. We present a case of a 26\u2010year\u2010old woman with Crohn's colitis, myasthenia gravis, and juvenile rheumatoid arthritis who presented with frequent bruising, epistaxis, and excessive bleeding from small cuts and who was found to be deficient in vitamin C. Plasma levels initially normalized with oral vitamin C supplementation, but bleeding symptoms eventually returned despite high\u2010dose oral supplementation with 2000 mg daily. She ultimately required routine intravenous supplementation in the home setting for the normalization of levels and the resolution of symptoms. Case reports of vitamin C deficiency typically involve patients with an inadequate intake of vitamin C\u2013containing foods or inadequate absorption. In contrast, our patient reported a regular intake of vitamin C\u2013containing foods, in addition to oral supplementation, but continued to have difficulty maintaining normal vitamin C levels. Scurvy should be considered for any patient with symptoms of bleeding, petechiae, or ecchymosis and, although it can typically be treated with oral vitamin C, intravenous repletion may be necessary in some cases.<\/jats:p>","DOI":"10.1002\/ncp.10800","type":"journal-article","created":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T14:37:32Z","timestamp":1637073452000},"page":"1242-1245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["High\u2010dose vitamin C therapy for symptomatic deficiency in a patient with myasthenia gravis and Crohn's disease"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3657-9221","authenticated-orcid":false,"given":"Jill","family":"Murphree","sequence":"first","affiliation":[{"name":"Nutrition Services Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7100-0564","authenticated-orcid":false,"given":"Diana Wells","family":"Mulherin","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Specialist, Pharmacy Clinical Programs Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Morton","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Adams","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"139","volume-title":"The ASPEN Adult Nutrition Support Core Curriculum","author":"McKeever L","year":"2017"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu9111211"},{"key":"e_1_2_8_4_1","volume-title":"Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids","author":"Institute of Medicine","year":"2000"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzab053_060"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdn076"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-018-02575-w"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2015.99"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31491-0"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190934"},{"key":"e_1_2_8_11_1","article-title":"From past sailors\u2019 eras to the present day: scurvy as a surprising manifestation of an uncommon gastrointestinal disease","volume":"2015","author":"Branquinho DF","year":"2015","journal-title":"Br Med J Case Rep"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-198608000-00012"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2010.29306"}],"container-title":["Nutrition in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ncp.10800","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ncp.10800","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ncp.10800","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T09:20:51Z","timestamp":1760952051000},"score":1,"resource":{"primary":{"URL":"https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ncp.10800"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1002\/ncp.10800"],"URL":"https:\/\/doi.org\/10.1002\/ncp.10800","archive":["Portico"],"relation":{},"ISSN":["0884-5336","1941-2452"],"issn-type":[{"value":"0884-5336","type":"print"},{"value":"1941-2452","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,16]]},"assertion":[{"value":"2021-11-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}