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Reversible Pulmonary Hypertension Associated With Vitamin C DeficiencyScurvy-Associated Pulmonary Hypertension

Markku Kupari, MD, PhD; Janne Rapola, MD, PhD
Author and Funding Information

From the Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.

Correspondence to: Markku Kupari, MD, PhD, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 Helsinki, Finland; e-mail: Markku.Kupari@hus.fi

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):225-227. doi:10.1378/chest.11-1857
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We describe the case of a 40-year-old female patient who developed severe pulmonary hypertension and life-threatening right-sided heart failure in association with dietary scurvy and iron deficiency. Supplementation with oral vitamin C and iron very likely contributed to her complete cure. Scurvy-associated pulmonary arterial hypertension could result from impaired availability of endothelial nitric oxide, but inappropriate activation of the hypoxia-inducible family (HIF) of transcription factors could play an even more important role. HIF coordinates the body’s responses to hypoxia, and its activity is regulated by oxygen-dependent prolyl hydroxylases, which need vitamin C and iron as cofactors. Deficiency of these cofactors could lead to uncontrolled HIF activity and pulmonary vasoconstriction responsive to vitamin C and iron administration.

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