Unexplained bleeding tendency and scleroderma-like skin changes: a diagnostic journey to vitamin C deficiency.

Background: A subset of patients with a bleeding tendency undergoing hemostatic evaluation may be misdiagnosed as bleeding disorder of unknown cause (BDUC). Key Clinical Question: Should vitamin C deficiency be considered in patients with bleeding symptoms but normal hemostatic test results suggestive of BDUC? Clinical Approach: We report on a patient with bleeding symptoms despite normal hemostatic examination, in whom vitamin C deficiency was ultimately identified as the cause of the bleeding disorder. The patient, a 26-year-old man, presented with extensive ecchymoses, anemia, and sclerodermatous skin changes of the left leg. His nutritional anamnesis revealed markedly restricted eating habits. Vitamin C supplementation led to normalization of hemoglobin levels and marked improvement of the sclerodermatous skin changes. Conclusion: This case demonstrates that vitamin C deficiency can mimic hematologic and dermatologic disorders and highlights the importance of considering nutritional deficiencies as potential causes of bleeding, even in high-income countries.