title: Varicella zoster virus-induced hemolytic crisis in an infant with severe vitamin B 12 deficiency.
abstract: BACKGROUND
  Vitamin B 12 deficiency is an uncommon disorder in infancy. Most cases are because of maternal deficiency resulting from insufficient storage and/or reduced intake and are generally seen in exclusively breast-fed infants. Accentuation of the hemolytic process has never been described in association with Varicella Zoster Virus (VZV) infections.
  
  
  METHODS
  We describe a 9-months-old breast-fed infant with megaloblastic anemia secondary to maternal vitamin B 12 deficiency. He presented severe pancytopenia and regression of motor functions and developed hemolytic crisis during a VZV infection.
  
  
  CONCLUSIONS
  Nutritional cobalamin deficiency should be considered in anemic infants with a history of prolonged exclusive breastfeeding and delayed developmental milestones. VZV infection can trigger a hemolytic process in infants with severe megaloblastic anemia secondary to B12 deficiency. A normal mean corpuscular volume does not rule out megaloblastic anemia, when the condition is combined with severe hemolysis.
authors.affiliation: UOC of Pediatrics, AO Carlo Poma, Pieve di Coriano, Mantova, Italy. francesca.lombardi@virgilio.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Lombardi
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Quitadamo
authors.forename: Lucia Dora
authors.initials: LD
authors.lastname: Notarangelo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pelizzoni
authors.forename: Paola
authors.initials: P
authors.lastname: Accorsi
authors.forename: Franco
authors.initials: F
authors.lastname: Olivetti
authors.forename: Richard Fabian
authors.initials: RF
authors.lastname: Schumacher
mesh_terms: D006461:Hemolysis; D006562:Herpes Zoster / Q000628:therapy / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D008297:Male; D010198:Pancytopenia / Q000628:therapy / Q000821:virology*; D016896:Treatment Outcome; D014806:Vitamin B 12 Deficiency / Q000150:complications*