A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension

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


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.

Publication types

  • Case Reports

MeSH terms

  • Ascorbic Acid / therapeutic use
  • Gingival Diseases / diagnosis*
  • Gingival Diseases / etiology
  • Humans
  • Hypotension, Orthostatic / diagnosis*
  • Hypotension, Orthostatic / etiology
  • Male
  • Middle Aged
  • Purpura / diagnosis*
  • Purpura / etiology
  • Scurvy / complications
  • Scurvy / diagnosis*
  • Scurvy / drug therapy
  • Vitamins / therapeutic use


  • Vitamins
  • Ascorbic Acid