PMC8024066_01
Peripheral ecchymosis which is commonly found as a cutaneous manifestation of scurvy.
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Physical exam revealed an extremely pale-appearing individual who had poor dental hygiene with mild pooling of blood in the oral cavity, diffuse joint swelling with ecchymosis (Figure 1), perifollicular petechiae with some corkscrew hairs (Figure 2), tenderness in the lower extremities, and decreased breath sounds with mild crackles.
Corkscrew hair and perifollicular petechiae which are commonly seen in scurvy.
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Physical exam revealed an extremely pale-appearing individual who had poor dental hygiene with mild pooling of blood in the oral cavity, diffuse joint swelling with ecchymosis (Figure 1), perifollicular petechiae with some corkscrew hairs (Figure 2), tenderness in the lower extremities, and decreased breath sounds with mild crackles.
This image was obtained by the transthoracic echocardiogram using a parasternal short-axis view. There is increased pressure/volume in the right ventricle and flattening of the interventricular septum creating a D-shaped right ventricle (known as a D-sign). In our case, this right ventricular strain is secondary to increased pressure in the pulmonary vasculature.
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A transthoracic echocardiogram (TTE) was ordered in the setting of bacteremia, which was negative to vegetation but was found to have severe pulmonary hypertension with a pulmonary artery systolic pressure of 86 mmHg, dilated inferior vena cava with a right atrial pressure of 15 mmHg, and severely enlarged right ventricle with flattening of the interventricular septum positive for D-sign (Figure 3).