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Required for collagen hydroxylation
7%
11/149
Required for dehydrogenase enzymes
57%
85/149
Required for methionine processing
11%
16/149
Required for methylmalonyl-CoA processing
Required for transketolase function
17/149
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This patient who was provided standard therapy for the acid fast tuberculosis organism most likely developed an isoniazid-mediated deficiency in niacin, which is required for dehydrogenase enzymes. Niacin (vitamin B3) is a water soluble vitamin that is a constituent of the NADH and NADPH cofactors used by many dehydrogenase enzymes. Though it can be made from tryptophan, the conversion process involves additional cofactors such as vitamin B2 and B6. Patients who are deficient in vitamin B3 develop pellagra, which presents with diarrhea, dermatitis, and dementia if left untreated. Causes of vitamin B3 deficiency include treatment of tuberculosis with the drug isoniazid because this drug inhibits the synthesis of niacin by blocking the vitamin B6 cofactor. Incorrect Answers: Answer 1: Required for collagen hydroxylation describes vitamin C, which would cause scurvy rather than pellagra when deficient. Answer 3: Required for methionine processing describes folate or cobalamin, which would cause a megaloblastic anemia rather than pellagra when deficient. Answer 4: Required for methylmalonyl-CoA processing describes cobalamin, which would cause a megaloblastic anemia rather than pellagra when deficient. Answer 5: Required for transketolase function describes thiamine, which would cause beriberi or Wernicke/Korsakoff syndrome rather than pellagra when deficient. Bullet Summary: Niacin (vitamin B3) deficiency causes pellagra, which presents with diarrhea, dermatitis, and dementia.
4.1
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