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[Metabolic complications and neurologic manifestations of vitamin B12 deficiency in children of vegetarian mothers].
[homocystinuria without methylmalonic aciduria]
Serious
hematological
,
metabolic
and
neurological
complications
owing
to
the
nutritional
deficiency
of
vitamin
B
12
may
occur
in
infants
of
mothers
on
a
strict
vegetarian
diet
.
The
mother
of
the
first
child
was
a
strict
vegetarian
.
She
had
an
elevated
urinary
methylmalonic
acid
level
and
a
low
concentration
of
serum
vitamin
B
12
.
Her
13
-
month
-old
daughter
was
exclusively
breast
-fed
until
the
age
of
9
month
and
then
she
was
fed
only
vegetables
.
Physical
examination
revealed
psychomotoric
retardation
,
apathy
,
muscular
hypotonia
,
abnormal
movements
and
failure
to
thrive
.
Laboratory
analysis
showed
a
megaloblastic
anaemia
,
a
low
level
of
vitamin
B
12
and
methylmalonic
aciduria
.
MRI
of
the
brain
revealed
diffuse
frontotemporoparietal
atrophy
and
retardation
of
myelination
.
After
treatment
with
vitamin
B
12
supplements
,
abnormal
movements
disappeared
and
development
improved
,
but
a
mild
generalised
hypotonia
continued
.
A
cranial
MRI
9
months
after
treatment
still
showed
signs
of
retardation
of
myelination
.
The
second
patient
,
an
8
month
-old
male
,
son
of
a
strict
vegetarian
mother
too
,
was
referred
for
investigation
of
psychomotoric
retardation
,
hypotonia
,
dyskinesia
,
failure
to
thrive
and
microcephaly
.
He
was
breast
-fed
and
from
6
month
of
age
he
had
also
received
fruit
juices
.
Laboratory
analysis
revealed
megaloblastic
anaemia
,
high
methylmalonic
aciduria
and
homocystinuria
.
The
patient
's
and
his
mother
's
serum
level
of
vitamin
B
12
were
low
.
After
treatment
with
vitamin
B
12
supplements
,
biochemical
and
metabolic
markers
of
disease
were
normal
but
there
continued
a
generalised
hypotonia
,
microcephaly
and
language
delay
.
Our
observations
emphasize
the
health
complications
of
nutritional
cobalamine
deficiency
and
a
requirement
of
clinical
,
biochemical
and
metabolic
monitoring
in
infants
within
strict
vegetarian
families
.
Diseases
Validation
Diseases presenting
"a low concentration of serum vitamin b12"
symptom
homocystinuria without methylmalonic aciduria
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