Thread by @hyderabaddoctor

Learning case for #doctors
1. 76-year-old man;
8-month history of statis #dermatitis, weakness and painful dysesthesias in the hands and feet.
Sensory-motor type #polyneuropathy was evident in a stocking-and-glove distribution, confirmed by nerve conduction studies.
#MedTwitter

2. Extensive testing including brain magnetic resonance imaging, spinal magnetic resonance imaging, and cerebral spinal fluid examinations were nondiagnostic.
Subsequently, serum vitamin B6 (VB6) levels were found to be low at 3.5 ng/mL (normal values: 6.0-40.0 ng/mL for males).

3. Oral supplementation with 60 mg/d of pyridoxal phosphate hydrate (PPH) was initiated, and 1 week later, VB6 levels rose to 39.3 ng/mL, and drastic improvements of polyneuropathy and dermatitis were observed. Pain reduced to 3 from 8 (scale of 0-10) after one week and 0 at 5 wk

4. The patient was wheelchair-bound on admission but became able to walk unaided within 3 weeks after initiation of PPH. As for dermatitis, a clear regression of the brown-reddish pigmentations was observed (Figure). Ref:doi.org/10.1016/j.amjm…

5. Causes/risk factors for VB6 deficiency- Alcohol dependence, chronic kidney disease, dialysis/post renal transplant, obesity, inflammatory bowel disease, post-bariatric surgery, Anti-Tb drug isoniazid, levodopa treatment in Parkinson's disease; pregnancy, rheumatoid arthritis.

6. Sources of VB6: Water-soluble vitamin B6 is widely present in many foods, including meat, fish, nuts, beans, grains, fruits, and vegetables.
Additionally, B6 is present in many multivitamin preparations for adults and children and is added to foods as a supplement to foods.