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CASE REPORT
A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension
  1. Jonathan Samuel Zipursky1,
  2. Ahmad Alhashemi1,
  3. David Juurlink2
  1. 1Department of Internal Medicine, University of Toronto, Toronto, Canada
  2. 2General Internal Medicine and Clinical Pharmacology, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Jonathan Samuel Zipursky, jonathan.zipursky{at}gmail.com

Summary

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.

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