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Pulmonary Hypertensive Crisis During General Anesthesia in a 3-Year-Old Autistic Boy With Undiagnosed Scurvy, Undergoing Cardiac Catheterization: A Case Report

Ichiyanagi, Shogo MD*; Takeshita, Itsuki MD*; Kandil, Ali I. DO, MPH; Miyazu, Mitsunori MD*; Kojima, Taiki MD*

doi: 10.1213/XAA.0000000000001087
Case Reports

Pulmonary hypertension in children is commonly caused by underlying cardiac and pulmonary disease. Within the past 10 years, scurvy has been identified as a cause for pulmonary hypertension. We describe the case of a 3-year-old autistic boy with undiagnosed scurvy who was scheduled for cardiac catheterization. Immediately after induction, the patient became hemodynamically unstable, which worsened with administration of nitrous oxide. Cardiac catheterization revealed pulmonary hypertension, which dramatically improved with administration of vitamin C. Anesthesiologists should be aware that scurvy is more common than previously thought, even in developed countries and can cause unexpected circulatory collapse from pulmonary hypertensive crisis.

From the *Department of Anesthesiology, Aichi Children’s Health and Medical Center, Aichi, Japan

Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Accepted for publication August 2, 2019.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Taiki Kojima, MD, Department of Anesthesiology, Aichi Children’s Health and Medical Center, 7–426 Morioka-cho, Obu-shi, Aichi 474–8710, Japan. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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