A recently published report describes the case of a 35-year-old female who developed severe pulmonary hypertension secondary to scurvy, which immediately resolved with vitamin C supplementation.

The patient presented to the hospital after experiencing lower extremity swelling, shortness of breath, gingival bleeding, decreased appetite, and worsening of ecchymosis over the past 6 months. Her medical history was significant for obesity, substance and tobacco abuse, major depressive disorder, anxiety, and poor dietary intake.

She had also been unsuccessfully treated with corticosteroids for suspected vasculitis/undifferentiated connective tissue disease, and had received transfusions for persistent anemia.

Physical examination revealed the patient to be pale, with poor dental hygiene and pooling of blood in the oral cavity. Joint swelling with ecchymosis, perifollicular petechiae and corkscrew hair, lower extremity tenderness, decreased breath sounds, and mild crackles were also observed.


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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,” the authors reported. “Although rare, thoracic medicine suspected the pulmonary hypertension was secondary to scurvy, and it would resolve with vitamin C supplementation as had been described in a few case reports.”

Vitamin C supplementation was initiated and ascorbic acid level testing confirmed severe deficiency (<0.1mg/dL) 2 days later. Her symptoms improved within a week of starting the supplements and she was discharged on vitamin C 500mg twice daily. Two weeks following initiation of vitamin C, a repeat TTE showed that the pulmonary hypertension had resolved. At a 2 year follow up, no evidence of pulmonary hypertension was observed. 

“As there are no current guidelines recommending looking for vitamin C deficiency as a culprit for pulmonary hypertension, it is likely that many cases are missed,” the authors concluded. “We believe that all individuals with the risk factors outlined above who are found to have pulmonary hypertension should be screened for vitamin C deficiency.”

Reference

Shah V, Shah RN, Greene L, DiMarino LM. Severe pulmonary hypertension in a patient with scurvy: Can vitamin reverse it? [published online March 30, 2021]. Case Rep Med. doi: 10.1155/2021/5519937