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Mehta A, Lynch W, Jha P. Vitamin B 12 deficiency presenting as neck pain and cervical radiculopathy. BMJ Case Rep 2024; 17:e259696. [PMID: 38663893 PMCID: PMC11043693 DOI: 10.1136/bcr-2024-259696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Vitamin B12 is required for the formation of haematopoietic cells and the synthesis of myelin. Deficiency typically presents with fatigue and megaloblastic anaemia. Prolonged deficiency can cause neurological symptoms such as paresthesia, which can progress to subacute combined degeneration of the spinal cord. We describe an unusual presentation of B12 deficiency in a young man who was initially diagnosed and treated for cervical radiculopathy. This case highlights the challenges of diagnosing B12 deficiency in patients with neurologic but without haematologic, abnormalities. While the current incidence of B12 deficiency in developed countries is low, cases are likely to rise with the increased adoption of veganism. Clinicians should be aware of the variable presentations of B12 deficiency because delayed diagnosis and treatment increases morbidity and can cause irreversible neurological deficits.
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Affiliation(s)
- Ashin Mehta
- Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Whitney Lynch
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Khadse S, Takalikar VS, Ghildiyal R, Shah N. Rare cause of recurrent hypocalcaemia and functional hypoparathyroidism due to hypomagnesaemia caused by TRPM6 gene mutation. BMJ Case Rep 2024; 17:e257505. [PMID: 38413141 PMCID: PMC10900374 DOI: 10.1136/bcr-2023-257505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Magnesium is essential for the functioning and release of parathyroid hormone. Therefore, its deficiency can present as functional hypoparathyroidism. This case report describes a rare inherited disorder called congenital hypomagnesaemia with secondary hypocalcaemia due to TRPM6 gene mutation. This disease clinically and biochemically mimics hypoparathyroidism. However, unlike hypoparathyroidism, it can be treated only by long-term oral magnesium supplements. The patient presented to us with recurrent hypocalcaemic convulsions. The laboratory picture in each admission was similar to that of hypoparathyroidism. However, the hypocalcaemia persisted, and it was noticed to be associated with persistent hypomagnesaemia. A defect in the tubular magnesium reabsorption was postulated and a genetic analysis of the patient was done, which revealed a TRPM6 mutation causing hypomagnesaemia by excessive renal excretion of magnesium. The child responded well to oral magnesium supplements and is currently developmentally appropriate for her age and thriving well.
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Affiliation(s)
- Savita Khadse
- Pediatrics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Vrushali Satish Takalikar
- Pediatrics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Radha Ghildiyal
- Pediatrics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Nikhil Shah
- Pediatrics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
- Division Of Pediatric Endocrinology, Department of Pediatrics, Surya Children's Hospital, Mumbai, India
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Akbar A, Lowther J, Creeden S, Frese W. Atypical Wernicke's encephalopathy without mental status changes following bariatric surgery in an adolescent patient. BMJ Case Rep 2024; 17:e255507. [PMID: 38296505 PMCID: PMC10831428 DOI: 10.1136/bcr-2023-255507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Morbid obesity is a systemic disease which can result in chronic complications, including hypertension, diabetes mellitus, depression, osteoarthritis and low self-esteem in the adolescent population.Bariatric surgery can be indicated to treat more severe forms of obesity, but these procedures are not without long-term risks. Therefore, adequate preoperative and postoperative care, which includes preoperative psychosocial evaluation for compliance, ongoing nutrition counselling and vitamin and micronutrient supplementation, is required for all patients, especially adolescent patients, who generally may not comply with medical therapies and/or be able to developmentally fully appreciate or comprehend the health consequences of their behaviours, prior to as well as after bariatric surgery to prevent complications.Thiamine pyrophosphate, an active form of thiamine (also known as vitamin B1, a water-soluble vitamin), which functions as a coenzyme in glucose and energy metabolism, is one such vitamin that requires supplementation postoperatively. It is mandatory for glucose to be administered concomitantly with thiamine, as glucose alone can precipitate Wernicke's encephalopathy (WE) in thiamine-deficient individuals. WE is a medical emergency, with a mortality rate of up to 20%. WE is best understood as a classic triad of mental confusion, gait ataxia and eye movement abnormalities, and atypical WE or Wernicke's syndrome (WS) is seen when the classic triad is not present. Cases that meet some, but do not necessarily meet all three criteria, are referred to as atypical WE or WS which can lead to delayed diagnosis. Atypical WE has an incidence of 19% which can lead to misdiagnosis of a preventable medical emergency with fatal complications.The following case reviews the consequences of post-bariatric thiamine supplementation therapy non-adherence and resulting in a deficiency in an adolescent patient.
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Affiliation(s)
- Asra Akbar
- Pediatric Neurology, University of Illinois college of medicine in peoria, Peoria, Illinois, USA
| | - Jason Lowther
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Sean Creeden
- University of Illinois Chicago College of Medicine at Peoria, Peoria, Illinois, USA
| | - William Frese
- University of Illinois Chicago College of Medicine at Peoria, Peoria, Illinois, USA
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Mathavan A, Mathavan A, Krekora U, Daily K. Immune-mediated herb-induced liver injury: a potential association with herbal artemisinin use as supported by the updated RUCAM. BMJ Case Rep 2023; 16:16/5/e251852. [PMID: 37142282 PMCID: PMC10163430 DOI: 10.1136/bcr-2022-251852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Immune-mediated herb-induced liver injury (HILI) is an acute or chronic inflammatory liver disease precipitated by a hepatotoxic agent with a presentation similar to acute autoimmune hepatitis. It is distinguished in clinical course from true autoimmune hepatitis by remission on drug discontinuation and immunosuppressive treatment. We report a potential case of immune-mediated HILI associated with artemisinin use, an herb underlying first-line malarial treatments, in a woman undergoing radiotherapy for right-sided pelvic sarcoma. A probable association in this case is supported by causality assessment using the updated Roussel Uclaf Causality Assessment Method (score of 6). She achieved clinical improvement with a course of oral corticosteroids and remained stable without relapse following discontinuation. Increased awareness of this complication is imperative, as literature to date only documents direct hepatocellular and cholestatic liver injury from artemisinin use, and should augment clinician counsel regarding complementary medicine administration, especially in high-risk individuals like those with cancer.
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Affiliation(s)
- Akash Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akshay Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Urszula Krekora
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Karen Daily
- Hematology and Oncology, University of Florida, Gainesville, Florida, USA
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Azar J, Ayyad M, Jaber Y, Ayasa LA. Scurvy-induced pulmonary arterial hypertension. BMJ Case Rep 2023; 16:16/4/e254730. [PMID: 37011995 PMCID: PMC10083756 DOI: 10.1136/bcr-2023-254730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature that results in precapillary pulmonary hypertension. PAH is caused by a group of clinical conditions involving multiple organ systems. Several cases have been reported in the literature demonstrating an association between vitamin C deficiency and PAH. Low endothelial nitric oxide levels in the pulmonary vasculature, combined with the inappropriate activation of hypoxia-inducible transcription factors, seen in patients with ascorbic acid deficiency, are believed to be the main contributors to the pathogenesis of pulmonary vasculopathy and the exaggerated pulmonary vasoconstrictive response seen in patients with scurvy-induced PAH. Vitamin C supplementation is considered the definitive treatment.
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Affiliation(s)
- Jehad Azar
- Pulmonary and Critical Care Department, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammed Ayyad
- Internal Medicine Department, Al Quds University, Abu Dis, State of Palestine
| | - Yasmin Jaber
- Oncology, Georgetown University, Washington, DC, USA
| | - Laith Azzam Ayasa
- Internal Medicine Department, Al Quds University, Abu Dis, State of Palestine
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Vidhale TA, Bhalde RP, Pande M, Mahure SP. Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis. BMJ Case Rep 2023; 16:16/3/e253752. [PMID: 36863757 PMCID: PMC9990648 DOI: 10.1136/bcr-2022-253752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
A man in his 20s who had previously experienced multiple episodes of transient loss of consciousness, majorly attributable to the seizures, presented with a 1-month history of increased seizure frequency, high-grade fever and weight loss. Clinically, he had postural instability, bradykinesia and symmetrical cogwheel rigidity. His investigations revealed hypocalcaemia, hyperphosphataemia, inappropriately normal intact parathyroid hormone, metabolic alkalosis, normomagnesemic magnesium depletion, and increased plasma renin activity and serum aldosterone concentration. CT scan of the brain revealed symmetrical calcification of the basal ganglia. The patient had primary hypoparathyroidism (HP). A similar presentation of his brother indicated a genetic cause, most likely autosomal dominant hypocalcaemia with Bartter's syndrome type 5. The patient's fever was caused by underlying haemophagocytic lymphohistiocytosis secondary to pulmonary tuberculosis, which triggered acute episodes of hypocalcaemia. This case represents a complex interplay of a multifaceted relationship between primary HP, vitamin D deficiency and an acute stressor.
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Affiliation(s)
- Tushar Ashok Vidhale
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Rucha Prafulla Bhalde
- Radiology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Minal Pande
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Shital Pradeep Mahure
- Pathology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Abstract
Vitamin B12 deficiency is a significant public health problem globally. Although it is a well-known cause of macrocytic anaemia and in advanced cases, pancytopenia, there remains a relative paucity of cases reported in pregnancy. It is associated with an increased risk of pregnancy complications and adverse birth outcomes such as neural tube defects, preterm birth, low birth weight, neurological sequelae and intrauterine death. It has a predilection for individuals aged >60 years. It has been implicated in a spectrum of neuropsychiatric disorders and it may also exert indirect cardiovascular effects. Severe vitamin B12 deficiency may present with haematological abnormalities that mimic thrombotic microangiopathy such as HELLP syndrome (haemolysis, elevated liver enzymes and low platelets) or it may present as pseudothrombotic microangiopathy (Moschcowitz syndrome) characterised by anaemia, thrombocytopenia and schistocytosis. It can also closely mimic thrombotic thrombocytopenia purpura, hence posing a diagnostic challenge to the unwary physician. Serological measurement of vitamin B12 levels confirms the diagnosis. Oral supplementation with vitamin B12 remains a safe and effective treatment. The authors describe the case of a multiparous woman in her late 20s presenting with a plethora of non-specific symptoms at 29+5 weeks' gestation. Her haemoglobin was 45 g/L, platelets 32×109/L, vitamin B12 <150 ng/L and serum folate <2 µg/L. She was not a vegetarian, but her diet lacked nutrition. Following parenteral B12 supplementation, her haematological parameters improved. The pregnancy was carried to term. Due to the plethora of non-specific symptoms, the diagnosis can be challenging to establish. Adverse maternal or fetal outcomes may occur. Folic acid supplementation may mask an occult vitamin B12 deficiency and further exacerbate or initiate neurological disease.
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Affiliation(s)
- Louise Dunphy
- Department of Obstetrics, Leighton Hospital, Cheshire, UK
| | - Ai-Wei Tang
- Department of Obstetrics, Liverpool Women's Hospital, Liverpool, UK
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Tasos E, Elliott E, Sharip MT, Massey D. Spontaneous haemopericardium due to vitamin K deficiency in an adult patient with cardiofaciocutaneous syndrome. BMJ Case Rep 2022; 15:15/12/e252047. [PMID: 36581361 PMCID: PMC9806001 DOI: 10.1136/bcr-2022-252047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We present the case of an adult man with cardiofaciocutaneous syndrome, who initially presented to the emergency department with severe abdominal pain and distension, but was diagnosed with cardiac tamponade on CT after distended neck veins and tachycardia were identified on examination. He had emergency pericardial drainage to relieve the haemopericardium and was treated with colchicine. He was further found to be deficient in factors II, VII and X despite not being on warfarin, and was therefore supplemented with vitamin K. This confirms a diagnosis of vitamin K deficiency, likely multifactorial from malabsorption due to chronic intestinal pseudo-obstruction, small bowel obstruction and possibly exacerbated by subsequent ciprofloxacin use for small intestine bacterial overgrowth. This is the first report of spontaneous haemopericardium secondary to vitamin K deficiency in an adult patient not on anticoagulation, and is an important learning point due to the life-threatening progression of the haemopericardium and cardiac tamponade.
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Affiliation(s)
- Emmanuel Tasos
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK .,University of Cambridge Medical Library, Cambridge, UK
| | - Elizabeth Elliott
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mohammed Tauseef Sharip
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dunecan Massey
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Barcena HA, Behaeddin BC, Abdi Z, Casadesus D. Wernicke's encephalopathy in a patient with hyperemesis gravidarum, hepatitis A and pancreatitis. BMJ Case Rep 2022; 15:15/12/e253982. [PMID: 36526285 PMCID: PMC9764603 DOI: 10.1136/bcr-2022-253982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hunter A Barcena
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Bita C Behaeddin
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Zakaria Abdi
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Karime C, Barrios MS, Wiest NE, Stancampiano F. Lactobacillus rhamnosus sepsis, endocarditis and septic emboli in a patient with ulcerative colitis taking probiotics. BMJ Case Rep 2022; 15:15/6/e249020. [PMID: 35764338 DOI: 10.1136/bcr-2022-249020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A man in his 60s presented to the emergency room with fever and fatigue after a 2.5-month course of corticosteroids. His medical history was significant for bioprosthetic aortic valve replacement and moderately severe ulcerative colitis treated with balsalazide and daily lactobacillus-containing probiotics. Initial investigations revealed Lactobacillus rhamnosus bacteraemia without complication. Four days after hospital discharge, the patient experienced acute-onset right-sided paraesthesia and lower-limb paresis. On return to the emergency room, MRI of the brain demonstrated innumerable ring-enhancing lesions with haemorrhagic transformation. Transoesophageal echocardiogram revealed a small mobile density on the bioprosthetic aortic valve, raising the suspicion for L. rhamnosus infective endocarditis with secondary septic emboli to the brain. The patient was subsequently treated with intravenous gentamycin and ampicillin, with transition to indefinite oral amoxicillin suppressive therapy. The current case highlights the potential risk of lactobacilli translocation in an immunosuppressed patient with ulcerative colitis taking probiotics.
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Affiliation(s)
- Christian Karime
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Maria S Barrios
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Nathaniel E Wiest
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
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Zhou JQ, Velimirovic M, Chang LL, Fenves AZ. Spontaneous haematomas and haematochezia due to vitamin C deficiency in a haemodialysis patient. BMJ Case Rep 2022; 15:15/5/e249711. [PMID: 35606035 DOI: 10.1136/bcr-2022-249711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 50s with dialysis-dependent end-stage renal disease, several weeks history of progressive skin bruising and acute-onset gastrointestinal bleeding presented to the emergency department following a syncopal event during routine haemodialysis owing to profound hypotension. He was found to have a severe normocytic, normochromic anaemia requiring several blood transfusions. He followed a diet lacking fruits and vegetables and stopped taking renal multivitamins. All parameters of coagulation were unremarkable, but serum vitamin C level was undetectable, supporting a diagnosis of scurvy. Although typically associated with individuals who are at risk of malnourishment, such as those with alcohol use disorder, malabsorption, and those who experience homelessness, scurvy should be considered in patients receiving renal replacement therapy as vitamin C is removed during haemodialysis.
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Affiliation(s)
- James Q Zhou
- Harvard Medical School, Boston, Massachusetts, USA.,Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marko Velimirovic
- Harvard Medical School, Boston, Massachusetts, USA .,Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leslie L Chang
- Harvard Medical School, Boston, Massachusetts, USA.,Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Z Fenves
- Harvard Medical School, Boston, Massachusetts, USA.,Clinician Educator, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Leonard P, Louw A, Prentice D, Cirillo M. Clonal cytopenia of undetermined significance and atypical Behçet's: the importance of zinc. BMJ Case Rep 2022; 15:e247154. [PMID: 35351745 PMCID: PMC8966545 DOI: 10.1136/bcr-2021-247154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/03/2023] Open
Abstract
Atypical Behçet's is recognised in myelodysplastic syndrome (MDS) cases and is associated with trisomy 8. Clonal cytopenia of undetermined significance (CCUS) is recognised as a precursor to MDS. Our case describes the presentation of atypical Behçet's, in association with CCUS, post a Streptococcal infection. A mutation of a zinc finger RNA spliceosome, ZRSR2, is also described. Our patient initially presented with macrocytic anaemia, together with neutropenia and lymphocytopenia on routine monitoring. Later gastrointestinal symptoms together with oral and anal ulcerations developed. He was treated with oral zinc therapy and had resolution of recurrent oral ulcerations and significant reduction in severity of anal ulcerations. The functional impact of ZRSR2 mutation on spliceosome assembly is yet to be defined, but has been previously reported in CCUS with a clinical phenotype of macrocytic anaemia.
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Affiliation(s)
- Patricia Leonard
- School of Medicine, Curtin University, Bentley, Western Australia, Australia
| | - Alison Louw
- Molecular Haematology, PathWest Laboratory Medical WA, Murdoch, Western Australia, Australia
| | - David Prentice
- Neurology, Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Melita Cirillo
- Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Reynolds A, O'Connell SM, Kenny LC, Dempsey E. Transient neonatal hypercalcaemia secondary to excess maternal vitamin D intake: too much of a good thing. BMJ Case Rep 2017; 2017:bcr-2016-219043. [PMID: 28687684 DOI: 10.1136/bcr-2016-219043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report a case of transient neonatal hypercalcaemia secondary to excess maternal vitamin D intake in pregnancy. Vitamin D insufficiency and deficiency in pregnancy are associated with adverse pregnancy outcomes, but there is no definite benefit to supplementation. The Royal College of Obstetrics and Gynaecology recommends routine supplementation with vitamin D3 400 IU/day, but higher dose preparations usually recommended for the treatment of vitamin D deficiency are readily available over the counter. This case highlights the risks of excess supplementation, especially at higher doses and in women without evidence of vitamin D deficiency. The amount used in this case was at the upper end of the generally accepted safe dose range, but still less than that commonly recognised to cause problems. Neonatal hypercalcaemia is a potentially serious condition. The current local or national recommendations for vitamin D supplementation and the possible adverse effects of excess vitamin D consumption should be clearly communicated to pregnant women.
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Affiliation(s)
- Adam Reynolds
- Department of Paediatrics and Child Health, Cork University Maternity Hospital, Cork, Ireland
| | - Susan M O'Connell
- Department of Paediatrics and Child Health, Cork University Hospital Group, Cork, Ireland
| | - Louise Clare Kenny
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, Cork University Maternity Hospital, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
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Moten M, Mussa M, Naqvi S, Kulkarni S. A rare case of a non-traumatic neck of femur fracture in a 17-year-old boy associated with vitamin D deficiency. BMJ Case Rep 2017; 2017:bcr-2017-219385. [PMID: 28385787 DOI: 10.1136/bcr-2017-219385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hip fractures in the young, healthy population are rare and often the result of high-energy trauma. A previously healthy 17-year-old patient presented to our institution with a 5-week history of left hip and knee pain in the absence of any trauma. Pelvic radiograph revealed a subacute left femoral neck fracture. He subsequently underwent surgical fixation and made an uneventful recovery. Further endocrine evaluation revealed isolated vitamin D deficiency to be the likely underlying cause for this fracture. Multiple previous opportunities were missed to identify the cause for this patient's symptoms. An intracapsular fracture in a young adult requires early recognition and prompt anatomical reduction. This case emphasises the need to maintain a high index of suspicion for atraumatic fractures in healthy adolescents with unexplained joint pain. Further endocrine and metabolic investigations are warranted, and isolated vitamin D deficiency must be considered as a potential causative factor.
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Affiliation(s)
- Maliha Moten
- Sandwell General Hospital, West Bromwich, Sandwell, UK
| | - Mohamed Mussa
- Sandwell General Hospital, West Bromwich, Sandwell, UK
| | - Syeda Naqvi
- Sandwell General Hospital, West Bromwich, Sandwell, UK
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