Vitamin C Deficiency as a Readily Reversible Cause of Pulmonary Hypertension

Pulmonary arterial hypertension (PAH) has a diverse range of etiologies and carries significant morbidity and mortality. Here, we describe a case of reversible PAH caused by scurvy. A 45-year-old woman presented with shortness of breath and was found to be in acute right heart failure owing to PAH. Physical examination demonstrated features of scurvy. She initially required vasopressors, supplemental oxygen therapy, and PAH therapies, but rapidly improved with vitamin C supplementation. Vitamin C plays a role in the nitric oxide pathway targeted by most PAH approved agents and others involved in pulmonary vascular modulation such as hypoxia inducible factor regulation, representing a rare cause of PAH. Clinical scurvy is uncommon but can present as reversible PAH and right-sided heart failure.