MYELOSIS FUNICULARIS AS A RESULT OF VITAMIN
B12/SECONDARY DEFICIENCY IN A 9-YEAR-OLD GIRL
Ilona Kopyta, Ewa Jamroz, Elzbieta Marszal
Upper Silesian Mother and Child Health Centre, Neurology Department,
ul. Medykow 16 40-752 Katowice
A nine year old girl with no family history or adverse pregnancy or
natal outcome, who underwent a resection of the end section of the small bowel
as a result of atresia in the first twenty four hours of her life, was admitted
to the Clinic on account of spastic paresis of the lower extremities. Apathy
and tiredness appeared the most striking features on the physical examination
of the child; likewise the pale colour of the integument and a scar on the
abdomen integuments - a result of the resection. Neurological examination
revealed pyramidal syndrome from the lower extremities, disturbed sense of
balance which intensified with eyes closed, and deep sensibility disorders.
Megaloblastic anaemia was revealed on further examinations, while the bone marrow
image showed normoblastic erythropoesis with the presence of megaloid cells,
extremaly low levels of vitamin B12 in the blood serum and a regular level of
folic acid; vitamin B12 absorption test showed considerable impairment in the
process; inflammation of the esophagus and duodenum mucosa, which was confirmed
in a histopathologic examination. Furthermore, irregulator somatosensory result
of induced potentials and a conductivity test revealed some characteristics of
axonal demyelination neuropathy in the lower extremities.
MRI of the head and spinal cord was correct. Diagnosis excluded
methylomalonic acidosis, multiple sclerosis and other causes of ataxia in
children. The overall clinical image, that is megaloblastic anaemia, the
characteristics of the myelosis funicularis and interview data - resection of
the bowel as well as other examinations confirm that the observed disorders
resulted from a deficiency in the absorbtion of vitamin B12. An appropriate
regimen duly implemented (intramuscular vitamin B12) improved the neurological
condition and hematologic parameters.
CONCLUSIONS:
It is imperative that the hematologic parameters and the neurologic conditions
should be monitored in the group of children who underwent the resection of the
ileum in infancy. If vitamin B12 deficiency symptoms occur, appropriate
treatment ought to be duly implemented.