A new case of vitamin B12 in a 5-month old vegetarian boy in Peru highlights that vegetarian organizations as well as nutrition and medical societies should raise vitamin B12 awareness among vegetarians.
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Hyperpigmentation in an Infant due to Vitamin B12 Deficiency
[...]A 5-month-old male infant from a rural community in Peru presented with a 1-month history of involuntary head movements lasting approximately 30 [seconds], which subsided with manual restraint. He was hospitalised, where he experienced intermittent nausea and vomiting. Physical examination revealed marked distal hyperpigmentation on the hands and feet [.see photo], along with upper-lip mucosal erosion.
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The mother reported being an ovo-vegetarian [...]. Specific testing revealed a markedly low serum vitamin B12 level (40.47 pg/mL) [i.e., vitamin B12 deficiency] [...].
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[Treatment:] The dose was 1000 μg [vitamin B12] intramuscularly per day for seven consecutive days, followed by 1000 μg [intramuscularly] once weekly for 8 weeks. The patient was discharged in good condition, with a serum B12 concentration of 2000 pg/mL [that is quite high! Maybe they overdid it a little. The question remains: Did the mother and boy change their diet afterwards? Because otherwise, vitamin B12 deficiency will develop again if animal product and B12-fortified food intakes remain low, without supplementation.]
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This case is notable due to the rare presentation of B12 deficiency with both neurologic and dermatologic symptoms in an infant. The mother's ovo-vegetarian diet likely resulted in inadequate B12 transfer through breastfeeding, leading to the infant's deficiency.
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Clinical manifestations [of vitamin B12 deficiency] in infants are usually nonspecific and typically appear between 4 and 12 months of age, when the limited stores of vitamin B12 are depleted [...].
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Clinicians [physcians and all health professionals] should maintain a high index of suspicion for vitamin B12 deficiency in infants—particularly when maternal diets are [...] vegetarian or vegan [...]. Early recognition can prevent irreversible hematologic and neurodevelopmental consequences.
Clinicians [physcians and all health professionals] should maintain a high index of suspicion for vitamin B12 deficiency in infants—particularly when maternal diets are [...] vegetarian or vegan [...]. Early recognition can prevent irreversible hematologic and neurodevelopmental consequences.
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