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An elderly recluse gentleman was brought to the medical clinic for an assessment. He had pallor, a smooth tongue, a palpable spleen, and petechiae adjacent to hair follicles (left panel). Laboratory work showed a moderate macrocytic anemia and leukopenia and minimal thrombocytopenia. The peripheral smear illustrated a few macroovalocytes and hypersegmented polys. He described no ill health but reported a diet that was exclusively boiled egg whites, water, and infrequent sips of milk. He offered no reason for this diet.
His unusual diet and pancytopenia raised the possibility of a nutritional megaloblastic anemia that was confirmed on the marrow examination (right panel). His B12 level was low and folic acid was normal. One week after B12 (10 mcg IM), his reticulocyte count increased and his white count was normalizing. However, the petechiae persisted. Vitamin C deficiency was suspected and an ascorbate blood level was noted to be rather low. High-dose oral ascorbate was started and th
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