Case Report Suggests Lack of Vitamin C as PAH Cause

Vitamin C deficiency can cause pulmonary arterial hypertension (PAH), a new case report suggests, highlighting the need to test vitamin C levels in people with PAH.

The report, “Vitamin C Deficiency-Induced Pulmonary Arterial Hypertension,” was published in the journal CHEST.

The study details the case of a man in his 60s with a history of systemic high blood pressure (hypertension), and difficulty breathing after exertion. The patient was hospitalized due to systemic hypertensive urgency — dangerously high blood pressure throughout the body, without an obvious cause or organ damage.

Right heart catheterization revealed a pulmonary artery systolic pressure of 72 mm Hg (normal range 18–25 mm Hg), confirming a PAH diagnosis.

At the time, the patient also had a rash on his lower limbs, and had been experiencing joint pain in the knees, hips, and feet for the past four months. Biopsy of the rash came back negative for autoimmune disease evaluation, but revealed the accumulation of hemosiderin (an iron-storage complex), as well as areas of fat necrosis (death of fat tissue). In addition, the patient had swollen gums.

Taken together, these features “were suggestive of severe vitamin C deficiency,” the researchers wrote, adding that “further questioning revealed that [the patient’s] diet consisted mainly of candy and sports drinks.”

The patient’s vitamin C levels were found to be under 0.1 mg/dL (normal range 0.2-2 mg/dL). Levels of iron, hemoglobin, and vitamin D also were below normal levels. As such, the patient was given vitamin C and vitamin D supplements.

Over the next five months, the patient’s rash and breathing difficulty were reduced, vitamin C levels increased to 1.5 mg/dL, and his estimated pulmonary artery systolic pressure decreased to 29 mm Hg.

“PAH resolved following repletion of vitamin C, suggesting vitamin C deficiency as the major cause of PAH,” the team wrote.

Interestingly, low vitamin C levels causing PAH has been reported before. However, in previous reports, additional iron supplements and/or PAH-specific treatment also were required to resolve the PAH.

“It is remarkable that in the study patient, vitamin C supplementation alone, without iron supplementation, was associated with reversal of PAH. Accordingly, vitamin C may alleviate some of the effects of iron deficiency as well,” researchers wrote, although further research is needed to validate this idea.

“The current case highlights the importance of checking vitamin C levels in patients with PAH at risk for vitamin C deficiency, as well as the potential therapeutic role of vitamin C supplementation in patients who are deficient,” the team concluded.

They added that more research is needed to investigate whether vitamin C supplementation could be beneficial to the broader PAH population, and not only to those at risk for vitamin C deficiency.