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Varicella Zoster Virus-induced Hemolytic Crisis in an Infant With Severe Vitamin B 12 Deficiency

Lombardi, Francesca MD*; Quitadamo, Anna Lucia MD*; Notarangelo, Lucia Dora MD; Pelizzoni, Alessandra MD; Accorsi, Paola MD*; Olivetti, Franco MD*; Schumacher, Richard Fabian MD

Journal of Pediatric Hematology/Oncology: May 2010 - Volume 32 - Issue 4 - p 317-318
doi: 10.1097/MPH.0b013e3181ced271
Clinical and Laboratory Observations

Background Vitamin B 12 deficiency is an uncommon disorder in infancy. Most cases are because of maternal deficiency resulting from insufficient storage and/or reduced intake and are generally seen in exclusively breast-fed infants. Accentuation of the hemolytic process has never been described in association with Varicella Zoster Virus (VZV) infections.

Observation We describe a 9-months-old breast-fed infant with megaloblastic anemia secondary to maternal vitamin B 12 deficiency. He presented severe pancytopenia and regression of motor functions and developed hemolytic crisis during a VZV infection.

Conclusions Nutritional cobalamin deficiency should be considered in anemic infants with a history of prolonged exclusive breastfeeding and delayed developmental milestones. VZV infection can trigger a hemolytic process in infants with severe megaloblastic anemia secondary to B12 deficiency. A normal mean corpuscular volume does not rule out megaloblastic anemia, when the condition is combined with severe hemolysis.

*U.O.C. of Pediatrics, A.O. Carlo Poma, Pieve di Coriano

Family Pediatrician, Mantova

Department of Pediatric Hemato-Oncology, Spedali Civili, Brescia, Italy

Reprints: Francesca Lombardi, MD, U.O.C. of Pediatrics, Pieve di Coriano, Via Bugatte no 1, C.A.P. 46020, Mantova, Italy (valid for all purposes) (e-mail:

Received for publication May 6, 2009; accepted November 30, 2009

© 2010 Lippincott Williams & Wilkins, Inc.