Pulmonary Hypertension Associated With Vitamin C Deficiency Is Rapidly Reversible

Area of Science:

• Pediatric Cardiology
• Nutritional Science
• Radiology

Background:

• Severe pulmonary hypertension (PH) in children is a critical condition.
• Nutritional deficiencies, including vitamin C deficiency, can contribute to complex pediatric health issues.
• Scurvy, a manifestation of severe vitamin C deficiency, can present with subtle radiographic findings.

Purpose of the Study:

• To report a series of children with severe pulmonary hypertension linked to vitamin C deficiency.
• To highlight the diagnostic clues and treatment response in these cases.
• To emphasize the reversibility of PH associated with vitamin C deficiency.

Main Methods:

• Case series of 4 children (aged 3-9 years) with severe PH.
• Clinical presentation, echocardiography, N-terminal pro-B-type natriuretic peptide levels, and nutritional status assessment.
• Radiologic review for subtle signs of scurvy.
• Treatment with vitamin C replacement, with some receiving sildenafil concurrently.

Main Results:

• All 4 children presented with severe PH, right ventricular dysfunction, and elevated NT-proBNP.
• Musculoskeletal symptoms and peripheral edema were common presentations.
• Subtle radiographic features of scurvy were noted in 2 patients.
• Rapid clinical and echocardiographic improvement occurred within 3 months of vitamin C therapy.
• One patient showed no response to sildenafil alone, responding only after vitamin C supplementation.

Conclusions:

• Vitamin C deficiency is a potentially reversible cause of severe pulmonary hypertension in children.
• Early recognition of nutritional deficiencies, including scurvy, is crucial for diagnosing PH.
• Vitamin C replacement therapy is the primary treatment for PH associated with vitamin C deficiency.