Case of Vitamin Deficiency

A 20-year-old male patient is admitted to the hospital 6 months ago following a motorcycle accident resulting in a severe closed head injury. The man has experienced recurrent fungal skin infections resistant to treatment for 1 month and severe vomiting over the last 2 days. Review of the patient’s records shows he was well before the injury. He now suffers severe permanent cognitive impairment and requires continuous high-dose phenytoin therapy to manage chronic debilitating tonic-clonic seizures. The patient is resting comfortably in no apparent distress. He is unable to converse coherently. Vital signs are normal. Physical exam is striking for nearly total alopecia. A periorofacial erythematous macular rash is present along with severe seborrheic dermatitis and several truncal ringlike lesions consistent with tinea corpus infection. Select the most likely vitamin deficiency. Answer Choices A. Vitamin A deficiency B. Vitamin B12 deficiency C. Vitamin C deficiency D. Vitamin D deficiency E. Vitamin E deficiency F. Thiamine deficiency G. Pyridoxine deficiency H. Folate deficiency I. Biotin deficiency Answer : I ​Symptoms of biotin deficiency develop within 3-5 weeks of the onset of deficient biotin intake. The most common cutaneous findings include the following:

Dry skin Seborrheic dermatitis Fungal infections Rashes, including erythematous periorofacial macular rash Fine and brittle hair Hair loss or total alopecia Approximately 1-2 weeks later, neurologic symptoms begin to develop. The most common neurologic findings include the following: Mild depression, which may progress to profound lassitude and, eventually, to somnolence Changes in mental status Generalized muscular pains (myalgias) Hyperesthesias and paresthesias Intestinal tract symptoms also develop and most commonly include the following: Nausea, occasionally severe Vomiting Anorexia