Coma and respiratory failure in a child with severe vitamin B(12) deficiency.
OBJECTIVE
Psychofunctional follow-up of severe vitamin B(12) deficit.


METHODS
Case report.


METHODS
Pediatric intensive care unit.


METHODS
Ten-month-old boy.


METHODS
Follow-up at 3 yrs.


RESULTS
A 10-month-old boy was admitted to the pediatric intensive care unit with respiratory failure, muscular hypotonia, and involuntary movements. Although a central nervous system infection was excluded, computed tomography scan showed a diffuse cortical-subcortical atrophy. Vitamin B(12) deficiency was suspected because of a red-cell count of 1,350,000/mm(3) and a hemoglobin value 5.9 g/dL (MCV 116). The baby had been exclusively breast-fed, but his mother had been a strict vegan for 10 yrs. Chronic dietary vitamin B(12) deprivation was confirmed by blood and urinary samples. Treatment with vitamin B(12) led in 2 wks to rapid and complete hematological improvement and to partial regression of neurologic symptoms. During the following 3 yrs the boy had normal vitamin intake and underwent intensive rehabilitative treatment. The brain atrophy regressed, but linguistic and psychomotor delay persisted.


CONCLUSIONS
Rapid clinical improvement after vitamin supply does not correlate with a complete recovery.
Codazzi
Daniela
D
Terapia Intensiva Pediatrica, Ospedali Riuniti, Bergamo, Italy.
Sala
Francesca
F
Parini
Rossella
R
Langer
Martin
M
D001942:Breast Feeding / Q000009:adverse effects*; D003128:Coma / Q000209:etiology*; D002658:Developmental Disabilities / Q000209:etiology; D014676:Diet, Vegetarian / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology*; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000209:etiology*