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Vitamin B6 Deficiency Polyneuropathy and Dermatitis

Published:September 25, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.09.009
      A 76-year-old man with an 8-month history of suspected statis dermatitis was admitted to our institution because of weakness and painful dysesthesias in the hands and feet. A sensory-motor type polyneuropathy was evident in a stocking-and-glove distribution, and nerve conduction studies confirmed these clinical findings. Polyneuropathy was worse in the lower extremities, and he was unable to walk. 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). 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. On a numerical rating scale, the painful dysesthesias in the lower extremities improved from 8 out of 10 to 3 out of 10 after 1 week of PPH administration, and to 0 out of 10 at 5 weeks after PPH administration. 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).
      Figure
      FigureVitamin B6 deficiency dermatitis. (A) Photograph of lower limbs before vitamin B6 supplementation. (B) Photograph of lower limbs 5 weeks after vitamin B6 supplementation.
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