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. 2014 May 23;2014:bcr2013201982.
doi: 10.1136/bcr-2013-201982.

A Rare Presentation of an Ancient Disease: Scurvy Presenting as Orthostatic Hypotension

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Case Reports

A Rare Presentation of an Ancient Disease: Scurvy Presenting as Orthostatic Hypotension

Jonathan Samuel Zipursky et al. BMJ Case Rep. .
Free PMC article

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.

Figures

Figure 1
Figure 1
The biosynthesis of catecholamines. Ascorbic acid facilitates the reduction of the trihydrobiopterin radical generated by the hydroxylation of tyrosine by tyrosine hydroxylase and acts as a cofactor for dopamine β hydroxylase.

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