Background Scurvy is thought to be a malady of the past; however, cases still arise in modern populations susceptible to vitamin deficiencies. Vitamin C deficiency notoriously presents as easy bruising, gingivitis, arthralgias, and corkscrew hair. Instead, this disease can mimic signs of vasculitis, which may lead to a delay of diagnosis. For instance, pulmonary arterial hypertension (PAH) is a rare complication of vasculitis, thought to arise from direct involvement of the pulmonary vasculature. To the present authors’ knowledge, the development of PAH in a case of scurvy has not been reported in modern publications. Here we present a case of scurvy in a young adult who presented with symptoms of vasculitis and associated PAH. Case Presentation A 30-year-old male with no medical history living in a major metropolitan city presents with myalgias, weakness, petechiae and profound shortness of breath. He has a history of heavy alcohol use in the months prior to admission but recently quit. He reports no drug use or recent bariatric surgery. On presentation, his vitals were stable. On examination, he has non-palpable red-purplish, reticular-appearing discoloration of skin in LE. Lab findings and peripheral blood smear showed macrocytic normochromic anemia with slight anisocytosis. Echocardiogram showed evidence of PAH with dilated right atrium and ventricle associated with elevated RVSP. There was concern for systemic vasculitis, but the laboratory workup, skin biopsy and immunofluorescence were negative. Urinalysis was positive for bilirubin and urobilinogen but negative for protein and casts. There was no improvement after Prednisone for 7 days. Due to the patients history of heavy alcohol use and negative vasculitis workup we requested a Vitamin C level which was undetectable. After supplementation, there was complete resolution of all symptoms. Hemoglobin returned to normal limits and PAH resolved. Discussion This case highlights vasculitis with signs of PAH as a rare representation of scurvy. The similarity poses a diagnostic challenge for healthcare providers as vitamin deficiencies are uncommon in major metropolitan cities. When confronted by a patient who is susceptible to vitamin deficiencies - such as those with a history of heavy alcohol use, nutritionally restricted diets, or psychiatric illness - physicians should not discount the diagnosis of Scurvy. By documenting this case, we hope to provide physicians with evidence to support the possibility of vitamin C deficiency during vasculitis workup.