title: A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension.
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.
authors.affiliation: Department of Internal Medicine, University of Toronto, Toronto, Canada.
authors.forename: Jonathan Samuel
authors.initials: JS
authors.lastname: Zipursky
authors.affiliation: Department of Internal Medicine, University of Toronto, Toronto, Canada.
authors.forename: Ahmad
authors.identifier: http://orcid.org/0000-0002-5052-959X
authors.initials: A
authors.lastname: Alhashemi
authors.affiliation: General Internal Medicine and Clinical Pharmacology, University of Toronto, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Juurlink
mesh_terms: D001205:Ascorbic Acid / Q000627:therapeutic use; D005882:Gingival Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011693:Purpura / Q000175:diagnosis* / Q000209:etiology; D012614:Scurvy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D001205:Ascorbic Acid