Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case reportReportar como inadecuado

Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Journal of Medical Case Reports

, 5:372

First Online: 12 August 2011Received: 09 February 2011Accepted: 12 August 2011DOI: 10.1186-1752-1947-5-372

Cite this article as: Rauf, M., Gleason, C., Nooka, A.K. et al. J Med Case Reports 2011 5: 372. doi:10.1186-1752-1947-5-372


IntroductionThe differential diagnosis of neutropenia includes medications, infections, autoimmune diseases, and deficiencies of Vitamin B12 and folate. The association of Vitamin B6 deficiency with severe neutropenia is a rare finding.

Case presentationA 51-year-old Caucasian woman presented with fever and profound neutropenia 48 neutrophils-uL. Her clinical history included non-Hodgkin lymphoma, in remission following treatment with allogeneic bone marrow transplantation, quiescent chronic graft-versus-host disease, and squamous cell carcinoma of the skin metastatic to cervical lymph nodes. Medications included atenolol, topical clobetasol, Ditropan oxybutynin, prophylactic voriconazole, prophylactic valganciclovir, Soriatane acitretin, and Carac fluorouracil cream. The bone marrow was hypocellular without metastatic cancer or myelodysplasia. Neutropenia did not respond to stopping medications that have been associated with neutropenia valganciclovir, voriconazole and Soriatane or treatment with antibiotics or granulocyte colony stimulating factor. Blood tests revealed absence of antineutrophil antibodies, normal folate and B12 levels, moderate zinc deficiency and severe Vitamin B6 deficiency. Replacement therapy with oral Vitamin B6 restored blood vitamin levels to the normal range and corrected the neutropenia. Her cervical adenopathy regressed clinically and became negative on scintography following Vitamin B6 therapy and normalization of the blood neutrophil count.

ConclusionSevere pyridoxine deficiency can lead to neutropenia. Screening for Vitamin B6 deficiency, along with folate and Vitamin B12 levels, is recommended in patients with refractory neutropenia, especially those with possible malabsorption syndromes, or a history of chronic-graft-versus host disease. Severe neutropenia may facilitate progression of squamous cell carcinoma.


EBVEpstein Barr virus

FDGfluro-deoxy glucose

G-CSFgranulocyte colony stimulating factor

GvHDgraft-versus-host disease

NKnatural killer cells

PET-CTpositron emission tomography-computerized tomography.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-5-372 contains supplementary material, which is available to authorized users.

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Autor: Mariam Rauf - Charise Gleason - Ajay K Nooka - Abbie Husman - Edmund K Waller


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