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[Myelosis funicularis as a result of secondary vitamin B12 deficiency in a 9-year-old girl].
Wiad Lek. 2002; 55(3-4):228-34.WL

Abstract

A nine-year-old girl without aggravating family history or adverse pregnancy and neonatal outcome, who underwent a resection of the end section of the small bowel as a result of atresia in the first twenty four hours of her life, was admitted to the Department on account of spastic paresis of the lower extremities. Apathy and tiredness appeared the most striking features on the physical examination of the child; likewise the pale colour of skin and a scar on the abdomen integuments--a result of the resection. Neurological examination revealed pyramidal syndrome from the lower extremities, disturbed sense of balance with intensified with closed eyes, and deep sensibility disorders. Megaloblastic anaemia was revealed on further examination, while bone marrow image showed normoblastic erythropoiesis with the presence of megaloid cells. The extremely low level of vitamin B12 in the blood serum and a regular level of folic acid were found. The vitamin B12 absorption test (Schilling test) showed considerable impairment in the process. The inflammation of the esophagus and duodenum mucosa was confirmed in a histopathological examination. Furthermore, irregular result of somatosensory induced potentials (SEP) and conductivity test revealed some characteristics of axonal--demyelinating neuropathy in the lower extremities. MRI of the head and spinal cord was correct. The diagnostics excluded methylomalonic acidosis, multiple sclerosis and other causes of ataxia in children. The overall clinical picture, that is megaloblastic anaemia, the characteristics of the myelosis funicularis and interview data--resection of the bowel as well as other examinations confirmed that the observed disorders resulted from the impairment of vitamin B12 absorption. An appropriate treatment consisted of supplementation of vitamin B12 (intramuscular) and folic acid (orally) improved the neurological condition and hematologic parameters.

CONCLUSIONS

It is necessary to monitor hematologic parameters and the neurologic condition in the group of children who underwent the resection of the ileum in infancy. If vitamin B12 deficiency symptoms occur, appropriate treatment should be duly applied.

Authors+Show Affiliations

Kliniki Neurologii Wieku Rozwojowego, Katedry Pediatrii, Slaskiej Akademii Medycznej w Katowicach.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

pol

PubMed ID

12182009

Citation

Kopyta, Ilona, et al. "[Myelosis Funicularis as a Result of Secondary Vitamin B12 Deficiency in a 9-year-old Girl]." Wiadomosci Lekarskie (Warsaw, Poland : 1960), vol. 55, no. 3-4, 2002, pp. 228-34.
Kopyta I, Jamroz E, Marszał E. [Myelosis funicularis as a result of secondary vitamin B12 deficiency in a 9-year-old girl]. Wiad Lek. 2002;55(3-4):228-34.
Kopyta, I., Jamroz, E., & Marszał, E. (2002). [Myelosis funicularis as a result of secondary vitamin B12 deficiency in a 9-year-old girl]. Wiadomosci Lekarskie (Warsaw, Poland : 1960), 55(3-4), 228-34.
Kopyta I, Jamroz E, Marszał E. [Myelosis Funicularis as a Result of Secondary Vitamin B12 Deficiency in a 9-year-old Girl]. Wiad Lek. 2002;55(3-4):228-34. PubMed PMID: 12182009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Myelosis funicularis as a result of secondary vitamin B12 deficiency in a 9-year-old girl]. AU - Kopyta,Ilona, AU - Jamroz,Ewa, AU - Marszał,Elzbieta, PY - 2002/8/17/pubmed PY - 2002/10/19/medline PY - 2002/8/17/entrez SP - 228 EP - 34 JF - Wiadomosci lekarskie (Warsaw, Poland : 1960) JO - Wiad Lek VL - 55 IS - 3-4 N2 - UNLABELLED: A nine-year-old girl without aggravating family history or adverse pregnancy and neonatal outcome, who underwent a resection of the end section of the small bowel as a result of atresia in the first twenty four hours of her life, was admitted to the Department on account of spastic paresis of the lower extremities. Apathy and tiredness appeared the most striking features on the physical examination of the child; likewise the pale colour of skin and a scar on the abdomen integuments--a result of the resection. Neurological examination revealed pyramidal syndrome from the lower extremities, disturbed sense of balance with intensified with closed eyes, and deep sensibility disorders. Megaloblastic anaemia was revealed on further examination, while bone marrow image showed normoblastic erythropoiesis with the presence of megaloid cells. The extremely low level of vitamin B12 in the blood serum and a regular level of folic acid were found. The vitamin B12 absorption test (Schilling test) showed considerable impairment in the process. The inflammation of the esophagus and duodenum mucosa was confirmed in a histopathological examination. Furthermore, irregular result of somatosensory induced potentials (SEP) and conductivity test revealed some characteristics of axonal--demyelinating neuropathy in the lower extremities. MRI of the head and spinal cord was correct. The diagnostics excluded methylomalonic acidosis, multiple sclerosis and other causes of ataxia in children. The overall clinical picture, that is megaloblastic anaemia, the characteristics of the myelosis funicularis and interview data--resection of the bowel as well as other examinations confirmed that the observed disorders resulted from the impairment of vitamin B12 absorption. An appropriate treatment consisted of supplementation of vitamin B12 (intramuscular) and folic acid (orally) improved the neurological condition and hematologic parameters. CONCLUSIONS: It is necessary to monitor hematologic parameters and the neurologic condition in the group of children who underwent the resection of the ileum in infancy. If vitamin B12 deficiency symptoms occur, appropriate treatment should be duly applied. SN - 0043-5147 UR - https://www.unboundmedicine.com/medline/citation/12182009/[Myelosis_funicularis_as_a_result_of_secondary_vitamin_B12_deficiency_in_a_9_year_old_girl]_ L2 - https://medlineplus.gov/malabsorptionsyndromes.html DB - PRIME DP - Unbound Medicine ER -