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Rauf M, Gleason C, Nooka AK, et al. Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report. J Med Case Rep. 2011;5:372doi: 10.1186/1752-1947-5-372.
Rauf, M., Gleason, C., Nooka, A. K., Husman, A., & Waller, E. K. (2011). Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report. Journal of medical case reports, 5372. https://doi.org/10.1186/1752-1947-5-372
Rauf, Mariam, et al. "Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report." Journal of medical case reports vol. 5 (2011): 372. doi: https://doi.org/10.1186/1752-1947-5-372
Rauf M, Gleason C, Nooka AK, Husman A, Waller EK. Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report. J Med Case Rep. 2011 Aug 12;5:372. doi: 10.1186/1752-1947-5-372. PMID: 21838907; PMCID: PMC3169495.
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J Med Case Rep. 2011 Aug 12;5:372. doi: 10.1186/1752-1947-5-372.

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

Journal of medical case reports

Mariam Rauf, Charise Gleason, Ajay K Nooka, Abbie Husman, Edmund K Waller

Affiliations

  1. Winship Cancer Institute, Emory University School of Medicine, 365B Clifton Road NE, Room B5119, Atlanta, GA 30322, USA. [email protected].

PMID: 21838907 PMCID: PMC3169495 DOI: 10.1186/1752-1947-5-372

Abstract

INTRODUCTION: The 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 PRESENTATION: A 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.

CONCLUSION: Severe 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.

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