Reversible Right Heart Failure in Scurvy Rediscovery of an Old Observation
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A previously healthy 50-year-old woman presented with 3 months of progressively worsening shortness of breath associated with extreme fatigue, anorexia, a 5 to 10 pound weight loss, yellowing of her eyes, heavy menstrual bleeding, and a lower extremity rash. She denied recent trauma.
She had never been admitted to the hospital before and had no history of surgical procedures. She took no medications. There was no significant family history. She was a housewife who had worked in the past as a secretary and had never smoked, drank alcohol, or used recreational drugs.
Physical examination revealed blood pressure 91/56 mm Hg, heart rate 92/min, respiratory rate 20/min, and temperature 37°C. Oxygen saturation was 85% on room air. Her skin and conjunctiva were pale, and scleral icterus was present. Her neck veins were distended to her earlobes when sitting, and there was massive hepatomegaly. A nonconfluent, nonblanching petechial rash was noted on her anterior legs (Figure 1A and 1B), and there was a large ecchymosis on her thighs and buttocks (Figure 2).
Laboratory data showed severe normocytic anemia with hemoglobin 3.4 g/dL, hematocrit 12%, mean corpuscular volume 90 fL, reticulocyte count 9.7%, serum iron 9 µg/dL, total iron binding capacity 271 …