{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:42:40Z","timestamp":1790934160998,"version":"4.1.0"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2011,8,12]],"date-time":"2011-08-12T00:00:00Z","timestamp":1313107200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1752-1947-5-372","type":"journal-article","created":{"date-parts":[[2011,8,12]],"date-time":"2011-08-12T18:23:41Z","timestamp":1313173421000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report"],"prefix":"10.1186","volume":"5","author":[{"given":"Mariam","family":"Rauf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charise","family":"Gleason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay K","family":"Nooka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbie","family":"Husman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund K","family":"Waller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2011,8,12]]},"reference":[{"key":"1734_CR1","first-page":"1","volume-title":"Hematology and Oncology MKSAP, 15th","author":"American College of Physicians","year":"2010","unstructured":"American College of Physicians: Hematopoietic Stem Cells and Their Disorders. Hematology and Oncology MKSAP, 15th. Edited by: Ansell JE, Mason BA. 2010, Philadelphia: ACP Press, 1-10."},{"key":"1734_CR2","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1126\/science.108.2802.284","volume":"108","author":"WW Hawkins","year":"1948","unstructured":"Hawkins WW, Barsky J: An Experiment on Human Vitamin B6 Deprivation. Science. 1948, 108: 284-286. 10.1126\/science.108.2802.284.","journal-title":"Science"},{"key":"1734_CR3","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1126\/science.100.2607.545-a","volume":"100","author":"MM Cantor","year":"1944","unstructured":"Cantor MM, Scott JW: Effect of Vitamin B6 (Pyridoxine) in the treatment of Leukopenia and Granulocytopenia of toxic origin in humans: preliminary report. 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Autoimmun Rev. 2009, 9: 62-66. 10.1016\/j.autrev.2009.03.006.","journal-title":"Autoimmun Rev"},{"key":"1734_CR6","first-page":"7","volume":"22","author":"A Spinneker","year":"2007","unstructured":"Spinneker A, Sola R, Lemmen V, Castillo MJ, Pietrzik K, Gonzalez-Gross M: Vitamin B6 status, deficiency and its consequences - an overview. Nutr Hosp. 2007, 22: 7-24.","journal-title":"Nutr Hosp"},{"key":"1734_CR7","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1016\/j.healun.2010.05.022","volume":"29","author":"A Vadnerkar","year":"2010","unstructured":"Vadnerkar A, Nguyen MH, Mitsani D, Crespo M, Pilewski J, Toyoda Y, Bermudez C, Kwak EJ, Silveira FP, Clancy CJ: Voriconazole exposure and geographic location are independent risk factors for squamous cell carcinoma of the skin among lung transplant recipients. 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