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A
10%
10/103
B2
55%
57/103
B6
21%
22/103
B7
5%
5/103
C
7%
7/103
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This patient is presenting with angular cheilitis, stomatitis, and dermatitis which is suggestive of riboflavin (vitmain B2) deficiency. Riboflavin acts as a cofactor in oxidation and reduction reactions within the body forming an important part of the composition of the electron carriers FAD and FMN. Riboflavin deficiency presents with sore throat, hyperemic and edematous oropharyngeal mucous membranes, glossitis, stomatitis, normocytic-normochromic anemia, photophobia, and dermatitis. Other vitamin deficiencies may also be present and may require additional investigation. Riboflavin can be found in many food types, including milk, cheese, meat, eggs, fish, green beans, asparagus, and leafy green vegetables. Figure A demonstrates angular cheilitis which is common in vitamin B2 deficiency. Incorrect Answers: Answer 1: Vitamin A (retinol) deficiency may cause night blindness and dry skin but would not cause angular cheilitis. Answer 3: Vitamin B6 (pyridoxine) deficiency could cause convulsions, hyperirritability, peripheral neuropathy, and a sideroblastic anemia. It is common in patients on isoniazid which is why patients on isoniazid are also started on vitamin B6. Answer 4: Vitamin B7 (biotin) deficiency is relatively rare but may cause dermatitis, alopecia, and enteritis. It can be caused by antibiotic use or excessive ingestion of raw eggs. Answer 5: Vitamin C deficiency causes scurvy which can present with bleeding gums, loose teeth, perifollicular hemorrhages, and easy fractures. Bullet Summary: Vitamin B2 (riboflavin) deficiency presents with angular cheilitis, glossitis, stomatitis, and hyperemic/edematous oropharyngeal mucous membranes.
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