Coma and respiratory failure in a child with severe vitamin B12 deficiency

Abstract

Psychofunctional follow-up of severe vitamin B12 deficit.

Case report.

Pediatric intensive care unit.

Ten-month-old boy.

Follow-up at 3 yrs.

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 B12 deficiency was suspected because of a red-cell count of 1,350,000/mm3 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 B12 deprivation was confirmed by blood and urinary samples. Treatment with vitamin B12 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.

Rapid clinical improvement after vitamin supply does not correlate with a complete recovery.