Abstract | November 17, 2023
Multi-System Effects of Poly-Vitamin Deficiencies in a Malnourished Patient
Learning Objectives
- Recognize signs of overlapping vitamin deficiencies and be able to differentiate between multivitamin deficiency and other pathologies with similar features based on clinical presentation and thorough history-taking.
Introduction: Vitamin deficiencies represent a broad class of pathology which have been well-documented for decades. However, the vague, non-specific pattern of disease that can often ensue lends to great diagnostic challenge. In this case, we study a patient presenting with severe nutritional deficiency with confounding signs of hematologic derangements and neurologic impairment.
Case Presentation: A 61-year-old female presented with a two-week history of progressive generalized weakness and worsening falls. Weakness had progressed from malaise to being unable to rise from bed. Associated symptoms were nausea, diarrhea, headache, and 30-pound unintentional weight loss over three months. Exam on arrival revealed bilateral weakness in upper and lower extremities, decreased grip strength, dysmetria on finger-to-nose testing, impaired proprioception, confusion, gingival bleeding, and diffuse bruising and petechiae. Lab workup revealed non-proliferative normocytic anemia (Hgb 8.0 g/dL, Reticulocyte Count 0.6%, MCV 96.4 fl) and thrombocytopenia (platelet count 45 TH/cmm). Peripheral smear revealed smudge cells without schistocytes, and additional work up for hemolysis was unrevealing. Flow cytometry was obtained due to concern for underlying hematologic malignancy in the setting of non-proliferative anemia, smudge cells, and unintentional weight loss; this revealed no pathognomonic elevations in CD antigens. On admission, a comprehensive workup for stroke-related symptoms, including a CT angiogram and non-contrasted CT of the head, yielded no evidence of ischemic changes or hemorrhage. Due to patient-reported poor nutritional intake, levels for vitamins B1, B6, B9, B12, C, D, and E were investigated with significant deficiencies found in all vitamins except vitamin E. Electromyography was obtained and was consistent with nutritional polyneuropathy with no findings to indicate inflammatory or autoimmune etiology.
Final Diagnosis: Deficiency of Multiple Nutrient Elements
Management/Outcome: Patient recovered significant neurologic function, and hematologic derangements were corrected with consistent dietary intake and supplementation of all deficient vitamins.
References and Resources
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