BMJ Case Reports 2013; doi:10.1136/bcr-2012-007938

Thiamine-responsive pulmonary hypertension

  1. Masayuki Ikeda4
  1. 1Department of Internal Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
  2. 2Department of Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan
  3. 3Department of Cardiology, Asahi General Hospital, Asahi, Chiba, Japan
  4. 4Department of Pharmaceutical Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
  1. Correspondence to Dr Takanori Asakura, takanori.asakura{at}
  • Received 8 November 2012
  • Revised 29 November 2012
  • Accepted 4 December 2012
  • Published 8 January 2013


The aim of this report is to call attention to a poorly recognised cause of pulmonary hypertension, thiamine deficiency. A 78-year-old woman without alcoholism or malabsorption presented with progressive dyspnoea and generalised oedema. Echocardiography showed signs of right ventricular overload with an estimated systolic pulmonary artery pressure of 50 mm Hg. Increased lactate concentrations prompted us to investigate thiamine deficiency. A 3-month history of picky eating, relying exclusively on white rice as the staple food, and low blood concentrations of thiamine confirmed the diagnosis. She recovered fully after 12 days of intravenous thiamine administration. Thiamine deficiency should be considered in all patients with pulmonary hypertension of unknown origin.

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