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Review Question - QID 210795

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QID 210795 (Type "210795" in App Search)
A 44-year-old woman presents to her primary care physician because she has been having fever, chest pain, and cough for the last several weeks. She presented to the physician because she discovered blood in her sputum after coughing. She recently returned from a year of traveling abroad, but has otherwise been healthy. Based on clinical suspicion, an acid fast stain is performed showing the causative organism, and she is started on appropriate therapy. Two weeks later, she returns with a skin rash, diarrhea, and confusion, and is given a factor to take in addition to the medications previously prescribed. Which of the following is a characteristic of the factor that was most likely provided?

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

7%

11/149

Required for transketolase function

11%

17/149

Select Answer to see Preferred Response

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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.

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