“Everything Is Falling Apart”: A Case of Severe B-Vitamin Deficiency

Background and Clinical Significance: B-vitamin deficiencies can lead to widespread diseases including cardiac, neurologic, hematologic, dermatologic, and oral pathologies. The often-multi-organ effects of B-vitamin deficiencies occur secondary to the roles that B-vitamins play in metabolism, myelin sheath formation, and deoxyribonucleic acid maintenance—key components of necessary processes for life; Case Presentation: The authors present an educational case of a 44-year-old female presenting with left-sided lower extremity cramps and bilateral lower extremity swelling, who on routine serological testing was found to have severe deficiencies of multiple B-vitamins—explaining her semiology; Conclusions: When B-vitamin concentrations fall below physiologically necessary levels, their dependent biochemical reactions cease, which can lead to devastating effects on the entire body, including but not limited to significant biochemical injury, disability, and/or death. Furthermore, one B-vitamin deficiency will often co-present with or co-precipitate other B-vitamin deficiencies for reasons that remain fairly unelucidated as of yet, despite numerous animal model studies. This case serves as a reminder that neurologic manifestations of systemic disease are common and that a wide differential, including metabolic causes of neurologic disease, should always be kept in the workup of patients with neurologic disease.