Vitamin C deficiency presenting with mucosal bleeding and worsening dyspnea in severe pulmonary arterial hypertension: a case report.

Background: Scurvy is rare in developed countries but continues to occur in individuals with limited dietary variety. Vitamin C deficiency is an underrecognized and potentially reversible cause of mucocutaneous bleeding, anemia, and systemic symptoms. We report a case of vitamin C deficiency presenting with mucosal bleeding and progressive dyspnea in a patient with severe pulmonary arterial hypertension (PAH). Case presentation: A 46-year-old woman with severe PAH and chronic iron deficiency anemia presented with progressive dyspnea, fatigue, extensive bruising, and mucosal bleeding. She was on stable triple therapy for PAH without recent medication changes. Laboratory evaluation demonstrated severe anemia with normal iron stores and profound vitamin C deficiency (<5.7 μmol/L). Oral ascorbic acid supplementation and dietary modification led to rapid resolution of mucosal bleeding and improvement in dyspnea, with stabilization of hemoglobin levels. Conclusions: This case highlights vitamin C deficiency as a reversible cause of mucocutaneous bleeding and anemia that may mimic or contribute to clinical deterioration in patients with complex cardiopulmonary disease. Consideration of micronutrient deficiencies may prevent unnecessary diagnostic evaluation and improve outcomes.