ABSTRACT
Background and objective Vitamin B1 deficiency can cause a variety of abnormalities in the neuropsychiatric, cardiovascular, and other systems. This condition can be rapidly corrected and prevented from progressing to irreversible sequelae through vitamin B1 supplementation. Therefore, early detection of and intervention in vitamin B1 deficiency are essential. We have previously demonstrated an association between vitamin B1 deficiency and appetite loss in hospitalized older adult patients in rural Japan. This study aimed to examine the additional predictors of vitamin B1 deficiency in patients with appetite loss and other symptoms suggestive of vitamin B1 deficiency. Material and methods This cross-sectional study involved 519 patients admitted to a rural hospital between April 2020 and March 2022. Data on vitamin B1 levels, age, sex, BMI, albumin levels, functional independence measure (FIM), hemoglobin levels, Charlson Comorbidity Index (CCI), and medications were collected from electronic medical records. Vitamin B1 deficiency was defined as serum vitamin B1 level <20 µg/dL. Data were analyzed using the Mann-Whitney U test, Student's t-test, and chi-square test, followed by multivariate logistic regression to examine the predictors of vitamin B1 deficiency. Results A total of 113 patients (21.5%) were found to be vitamin B1-deficient. Multivariate logistic regression showed that anemia was significantly associated with vitamin B1 deficiency [adjusted odds ratio (AOR): 1.71, 95% confidence interval (CI): 1.07-2.73, p<0.05]. Conclusion Based on our findings, anemia is significantly associated with vitamin B1 deficiency in hospitalized Japanese patients living in rural areas. Therefore, physicians should be mindful of the possibility of vitamin B1 deficiency in hospitalized patients with anemia.
ABSTRACT
Adult-onset Still's disease (AOSD) is a systemic inflammatory disease characterized by rash, arthritis, and persistent spiking fever. The diagnosis and treatment of AOSD are challenging due to the lack of specific diagnostic criteria and little evidence of effective treatments. Here, we reported a case of an 18-year-old woman with a fever of unknown origin (FUO), evanescent rash (without the typical "salmon-pink" color), and systemic lymphadenopathy. Laboratory tests at hospital admission revealed marked hyperferritinemia of 12,100 ng/mL. AOSD was subsequently suspected. Additional anti-nuclear-antibody analysis for differential diagnosis was negative. The initiation treatment with high-dose prednisolone, tapered to half every week, was immediately started. The symptoms temporarily improved but relapsed during the tapering period. The prednisolone dose was increased again, and tocilizumab was introduced. Symptom remission and prednisolone dose reduction were subsequently achieved. Therefore, a medication tapering schedule and treatment replacement to inhibit the pathophysiology of AOSD need to be carefully considered. While a ferritin test is useful to diagnose AOSD based on the presence of FUO, there are AOSD patients without hyperferritinemia. Additionally, AOSD rash on Asian skin may not present with the typical "salmon-pink" color.
