A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension.
BMJ Case Rep. 2014 ;2014. Epub 2014 May 23. PMID: 24859547
Jonathan Samuel Zipursky
A 49-year-old man presented to hospital with severe orthostatic hypotension, gingival dysplasia and a purpuric rash involving his extremities. The orthostatic hypotension failed to respond to fluids and, on the basis of physical examination and dietary history, the patient was given a preliminary diagnosis of scurvy (ascorbic acid deficiency). Serum ascorbic acid levels were undetectable and the orthostasis was resolved within 24 h of ascorbic acid replacement. The pathogenesis of orthostatic hypotension in the setting of scurvy appears to involve impaired catecholamine synthesis and attenuated vasomotor response to α-adrenergic stimulation. We believe that this case describes a rare presentation of scurvy and highlightsa previously under-reported connection between scurvy and vasomotor instability.