Review Question - QID 109006

This patient is presenting with angular chelitis and seborrheic dermatitis suggesting a diagnosis of vitamin B2 (riboflavin) deficiency.

Riboflavin is a water soluble vitamin that can be deficient in malnourished patients. Riboflavin deficiency classically presents in a malnourished patient with angular chelitis (Figure A), stomatitis, glossitis, and seborrheic dermatitis (Figure B). This patient seems to be depressed and is no longer caring for himself making malnutrition likely. The only diagnosis that can explain his physical exam findings of both angular chelitis and seborrheic dermatitis is vitamin B2 deficiency.

Figure A demonstrates angular chelitis, a common physical exam finding with riboflavin deficiency. Figure B demonstrates the flaky, greasy appearance of seborrheic dermatitis.

Incorrect Answers:
Answer 1: Vitamin B1 (thiamine) deficiency could present with beriberi which presents with CHF and peripheral neuropathy. Though this patient is suffering from CHF (as revealed by his pulmonary crackles and lower extremity edema) this is a condition that he seems to have had for awhile given is past medical history and the appropriate treatment for this condition (beta-blockers and ACE inhibitors). In addition, thiamine deficiency would not explain his findings of seborrheic dermatitis and angular chelitis.

Answer 3: Vitamin B3 (niacin) deficiency could cause pellagra which presents with dementia, diarrhea, dermatitis, and, if untreated, death.

Answer 4: Pityrosporum ovale is the fungal agent that can cause seborrheic dermatitis, however, its presence would not explain the finding of angular chelitis.

Answer 5: Parkinson disease presents with a tremor at rest that improves with activity (in contrast to this patient's tremor with activity suggestive of benign essential tremor). Other symptoms include a stooped, festinating gait, cogwheel rigidity, and slow movements. Seborrheic dermatitis can occur with increased frequency in Parkinson disease as can depression. However, this patient's tremor does not resemble that of Parkinson disease, and there are no other physical exam findings suggesting a diagnosis of Parkinson disease.

Bullet Summary:
Vitamin B2 (riboflavin) deficiency occurs in malnourished patients and presents with angular chelitis, stomatitis, glossitis, and seborrheic dermatitis.