Severe vitamin C deficiency is a rare cause of pulmonary arterial hypertension (PAH) that is easily treatable, according to a case study by Shrey Shah and colleagues published in Chest and being presented at the Chest 2021 Annual Meeting. It should, therefore, be considered in the appropriate clinical setting.

The researchers presented the case of a 40-year-old woman with beta-thalassemia trait who presented with swelling in her legs and feet and fainting for the past several months. She reported having allergies to a variety of fruits and vegetables.

Physical examination showed that she had bleeding gums, bruises, edema of both legs and feet, and jugular venous distention. Laboratory tests revealed anemia and high brain natriuretic peptide levels but normal kidney function. 

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The patient’s lungs were clear upon chest X-ray examination, but based on echocardiogram and right heart catheterization, she was diagnosed with PAH.

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When the patient was evaluated nutritionally, her vitamin C levels were less than 0.1 mg/dL. She was, therefore, diagnosed with severe vitamin C deficiency. Because vitamin C is involved in nitric oxide synthesis, vitamin C deficiency can lead to a disruption in the nitric oxide pathway, resulting in PAH. 

“Our patient developed severe vitamin C deficiency due to nutritional deficiencies resulting in pulmonary hypertension,” the researchers wrote. “Supplementation of vitamin C resulted in a marked improvement in her symptoms and hemodynamics without the need for vasodilator therapy.”

PAH is a rare chronic disease that can be drug- or toxin-induced, idiopathic, hereditary, or associated with other conditions such as connective tissue diseases, portal hypertension, congenital heart disease, human immunodeficiency virus infection, and schistosomiasis. Once the common causes of PAH have been ruled out, potential new causes should be considered, the researchers wrote.

The Chest 2021 Annual Meeting is being held virtually Oct. 17-20, 2021.


Shah S, Garg D, Patel P, Kuchipudi N. A case of pulmonary arterial hypertension from vitamin C deficiency. Chest. Published online October 1, 2021. doi:10.1016/j.chest.2021.07.1928