title: Pulmonary hypertension associated with scurvy and vitamin deficiencies in an autistic child.
abstract: Restricted dietary intake is common among children with behavioral issues. Here we report a case of a severely autistic child who presented initially with limp but who soon developed cough, tachypnea, hypoxia, and tachycardia. An echocardiogram revealed evidence of pulmonary hypertension (PH) with severely dilated right ventricle and elevated right-sided pressures. The etiology of his PH was unclear but further laboratory evaluation demonstrated severe nutritional deficiencies, in particular an undetectable ascorbic acid (vitamin C) level as well as deficient levels of thiamine (vitamin B1), pyridoxine (vitamin B6), cobalamin (vitamin B12), and vitamin D. Repletion of these vitamins was associated with resolution of his PH and his musculoskeletal complaints. We report this case and a review of the relevant literature as a clinical lesson to expand the differential diagnosis of limp in children who may be difficult to assess as well as to report on an unusual association between severe vitamin deficiencies and PH.
authors.affiliation: Boston Children's Hospital, Division of Critical Care Medicine, Department of Anesthesia, 300 Longwood Ave, Boston, MA 02115. melody.duvall@childrens.harvard.edu.
authors.forename: Melody G
authors.initials: MG
authors.lastname: Duvall
authors.forename: Yana
authors.initials: Y
authors.lastname: Pikman
authors.forename: David B
authors.initials: DB
authors.lastname: Kantor
authors.forename: Katelyn
authors.initials: K
authors.lastname: Ariagno
authors.forename: Lisa
authors.initials: L
authors.lastname: Summers
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Sectish
authors.forename: Mary P
authors.initials: MP
authors.lastname: Mullen
mesh_terms: D002648:Child; D002659:Child Development Disorders, Pervasive / Q000150:complications* / Q000523:psychology; D005247:Feeding Behavior; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D012614:Scurvy / Q000150:complications / Q000175:diagnosis*; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis*
keywords: nitric oxide; pulmonary hypertension; restrictive eating; scurvy; vitamin deficiency