A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension
- 1Department of Internal Medicine, University of Toronto, Toronto, Canada
- 2General Internal Medicine and Clinical Pharmacology, University of Toronto, Toronto, Canada
- Correspondence to Dr Jonathan Samuel Zipursky,
- Accepted 6 May 2014
- Published 23 May 2014
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.