Review Question - QID 108787

This patient is presenting with dermatitis, neuropathy, and an elevated homocysteine level suggesting a deficiency of the water soluble vitamin B6 (pyridoxine).

This patient is on the wrestling team and recently lost a considerable amount of weight which should raise concern for a nutritional deficiency. In addition, his chief complaint of dermatitis narrows the diagnosis to vitamin B2 or B6 deficiency. Further evidence supporting a diagnosis of vitamin B6 deficiency is provided by the mood changes and neuropathy that occur as well. Finally, this patient has an elevated homocysteine level which can occur in the setting of B6 deficiency (though it can also occur in the setting B12 and B9 deficiency). It is the entire clinical picture of dermatitis, neuropathy, mood changes, and elevated homocysteine that points toward the diagnosis of vitamin B6 deficiency.

Incorrect Answers:
Answer 2: Anabolic steroid use may be involved with this patient's acne and recent mood changes; however, it does not explain the elevated homocysteine level, the dermatitis, or the neuropathy. Anabolic steroid use should be suspected in strength athletes when the clinical picture is appropriate.

Answer 3: Dermatologic fungal infection refers to tinea corporis or "ringworm" which is a common disease that affects athletes who come into close contact with others in warm, humid conditions (such as wrestling). A pruritic, annular skin lesion would be classic for this pathology but would not explain the other neurological, psychological, or lab findings.

Answer 4: Depression secondary to dietary changes can occur in individuals who consume extremely low amounts of carbohydrates or calories. This patient does present with several criteria for depression such as loss of energy and trouble concentrating; however, the entire clinical picture cannot be explained by merely depression.

Answer 5: Viral infection could represent infectious mononucleosis which would present with fatigue and mood changes as seen in this patient. However, it would also present with posterior cervical lymphadenopathy and tonsillar exudates. Furthermore, dermatitis and peripheral neuropathy are not classic findings in this disease.

Bullet Summary:
Vitamin B6 (pyridoxine) deficiency presents with dermatitis, neuropathy, stomatitis, and mood changes and can occur in patients with inadequate dietary intake or sudden weight loss.