Pulmonary Hypertension Associated With Vitamin C Deficiency Is Rapidly Reversible.
- 2026-03-17
- Pediatrics 157(4)
- Tomás Woodgate
- Jay Patel
- Thomas Day
- Brodie Knight
- Adriani Spanaki
- Alistair Calder
- Shahin Moledina
- Sadia Quyam
- PubMed: 41839225
- DOI: 10.1542/peds.2025-073645
Study Design
- Type
- Case Report
- Population
- 4 children (aged 3-9 years) with severe pulmonary hypertension (PH) associated with vitamin C deficiency
- Methods
- All children received vitamin C replacement therapy, with 3 also receiving concurrent sildenafil
- Duration
- within 3 months
We report 4 children (aged 3-9 years) with severe pulmonary hypertension (PH) associated with vitamin C deficiency. All presented with either musculoskeletal symptoms or cardiorespiratory deterioration with peripheral edema. Multiple nutritional deficiencies were identified in all children, and 2 had autistic spectrum disorder. Initial echocardiography results demonstrated severe PH with right ventricular dysfunction and significantly elevated N-terminal pro-B-type natriuretic peptide levels. In 2 patients presenting with musculoskeletal symptoms, specialist radiologic review revealed subtle features of scurvy that provided early diagnostic clues before laboratory confirmation. Vitamin C levels were undetectable where samples were processed prior to replacement, highlighting the importance of securing viable samples before treatment initiation for diagnostic certainty. All children received vitamin C replacement therapy, with 3 also receiving concurrent sildenafil. Remarkably, all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation, with complete resolution within 3 months. Importantly, 1 child receiving sildenafil alone showed no therapeutic response until vitamin C was added, indicating that improvement requires correction of the underlying deficiency rather than pulmonary vasodilation alone. This case series demonstrates rapid reversibility of vitamin C deficiency-associated PH and emphasizes the importance of considering this diagnosis in children with restricted diets and unexplained PH.
Research Insights
Initial echocardiography results demonstrated severe PH with right ventricular dysfunction ... all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation, with complete resolution within 3 months.
- Effect
- Beneficial
- Effect size
- Large
Remarkably, all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation, with complete resolution within 3 months.
- Effect
- Beneficial
- Effect size
- Large
significantly elevated N-terminal pro-B-type natriuretic peptide levels ... all demonstrated rapid clinical and echocardiographic improvement following vitamin C initiation
- Effect
- Beneficial
- Effect size
- Large