Answer to Hypotonia: A Simple Hemogram

Abstract

A 1-year-old boy with weight loss, decreased activity, and psychomotor regression is presented. He was subjected to an extremely detailed evaluation, including electroencephalography (EEG) and magnetic resonance imaging (MRI), until a simple hemogram in our center revealed that he had macrocytic anemia with megaloblastic changes in the bone marrow. His history revealed that he had been exclusively breast-fed by his vegetarian mother. Further investigations showed low serum vitamin B₁₂ concentration, methylmalonic aciduria, and homocysteinemia, indicating that the macrocytic anemia was due to vitamin B₁₂ deficiency. This boy represents a case of macrocytic anemia and hypotonia owing to vitamin B₁₂ deficiency that developed because of exclusive breast-feeding by a vegetarian mother. (J Child Neurol 2005;20:930—931).

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