Folate deficiency presenting as pyrexia!!

[Chandrima]

Hello, my 29-year-old caucasian male colleague in USA presented to our medical admissions unit complaining of a 6 week history of dyspnoea on exertion, recurrent fevers and sweats. He had a 7 year history of alcohol excess, drinking 3–4 litres of cider per day. He was a smoker of 10 cigarettes per day, but was otherwise fit and well with no significant past medical or family history. The patient reported no other symptoms and did not take any regular medication. Examination revealed a pulse rate of 124 beats/minute and a blood pressure of 120 mmHg/48 mmHg. He was noted to be febrile with a temperature of 38.8°C. Oxygen saturations were 100% on room air with no signs of respiratory distress. Serum folate levels were found to be low at 1.2 ug/L (normal range 4–24 ug/L) and vitamin B12 levels were low-normal at 202 ng/L (normal range 180–900 ng/L). Iron studies were normal. Initial blood film and subsequent bone marrow examination confirmed a severe megaloblastic picture, consistent with folate deficiency. How to treat folate deficiency?

[Sudeshna]

@chandrima Treatment involves increasing the dietary intake of folate. You can also take a folate or folic acid supplement. Those with a genetic mutation that affects folate absorption, known as MTHFR, need to take methylated folate in order to avoid deficiency. Folate is frequently combined with other B vitamins in supplements. These are sometimes called vitamin B complexes. Pregnant women should completely avoid alcohol, and everyone else with a folate deficiency should decrease their alcohol intake.