A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension. (23rd May 2014)

• Record Type: Journal Article
• Authors: Zipursky, Jonathan Samuel; Alhashemi, Ahmad; Juurlink, David
• Is Part Of: BMJ case reports. Volume 2014
• Publication Date: 2014-05-23
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2013-201982
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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 highlights a previously under-reported connection between scurvy and vasomotor instability.