Has vasculitis or erythema multiforme been described in connection with oral Vitamin B12 treatment?

Fråga: Has vasculitis or erythema multiforme been described in connection with oral Vitamin B12 treatment?

An otherwise healthy 83-year-old man has been treated with Behepan tablets (hydroxycobalamine) 1.0 mg daily for many years. Hypochylin (glutamine acid) was added last summer. Early in 1996 he developed erythema all over the body. A skin biopsy showed vasculitis and erythema multiforme, probably drug-induced.

Sammanfattning: In the present case it seems unlikely that Behepan should have caused vasculitis, as this has not previously been described in the literature and as the patient had been treated for several years prior to this disease. Vasculitis and erythema multiforme may be induced by viral or bacterial infection, due to other drugs taken occasionally (aspirin, for example) or without any apparent reason.

Svar: A thorough literature search, including Medline, the files of the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) and common pharmacological handbooks, has not revealed any case reports concerning erythema multiforme or vasculitis induced by vitamin B12. Urticaria and acneiform eruptions are known but rare, side-effects of vitamin B12 treatment. Seventeen cases of dermal side-effect have been reported to SADRAC including urticaria, exanthema and edema. All reactions except one occurred within the first two months of treatment, usually within days. In one case, a woman had reddish swelling of the left leg after her sixth injection of Betolvex.