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Pathology · patient case question

A different patient presents with erythematous gingiva and an atrophic, depapillated tongue. Which vitamin deficiency does this combination most suggest?

Patient case: Man with bleeding gums, easy bruising and poor wound healing

Patient: Male, 45 years old

Chief complaint: “My gums bleed a lot.”

Background: Vitamin C deficiency. Depression.

Current findings: Easy bruising, poor wound healing, bone pain. Periodontal disease.

  1. Vitamin D
  2. Vitamin C
  3. Vitamin K
  4. Vitamin E
Show answer and explanation

Correct answer: B. Vitamin C

  • A. Vitamin D deficiency affects mineralisation — rickets and osteomalacia — not gingival bleeding.
  • B. CORRECT. The combination of erythematous, bleeding gingiva with papillary atrophy points to vitamin C deficiency.
  • C. Vitamin K deficiency impairs clotting factors II, VII, IX and X, producing bleeding, but not papillary atrophy of the tongue.
  • D. Vitamin E deficiency is rare and causes neurological and haemolytic problems.

Note: B-vitamin deficiencies also cause glossitis. B2 gives angular cheilitis and a magenta tongue; B12 and folate give a beefy red tongue with anaemia.

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