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Progressive Hyperpigmentation in a Child: An Early Marker of Infantile Tremor Syndrome

Received: 13 July 2021    Accepted: 2 August 2021    Published: 4 September 2021
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Abstract

Hyperpigmentary disorders are commonly encountered group of dermatoses in the paediatric age group. One of the most common causes of progressive generalised hyperpigmentation in paediatric population is nutritional vitamin B12 deficiency (NVBD). NVBD can present with a bunch of signs and symptoms like skin hyperpigmentation, pallor and regression of neurodevelopment. We report a case of a plump looking 13 months old, girl child from non-consanguineous marriage of low socioeconomic family who presented with generalised hyperpigmentation, failure to thrive and regression of mile stones. Physical examination revealed anaemia and sparse, thin, lustreless hair with dull, apathetic look. A differential diagnosis of Addison’s disease, hypothyroidism, and neurodegenerative disease, was considered based on clinical suspicion. She was further investigated by a paediatrician. Her blood investigations revealed low levels of Vitamin B12 (159 pg/dl) and haemoglobin (2.6 g/dl). On radiological examination, NCCT brain showed cortical atrophy. A final diagnosis of Infantile Tremor Syndrome (ITS) was made. ITS is a rare condition which presents with cutaneous manifestation like hyperpigmentation, scanty scalp hair along with lethargy, apathy along with signs and symptoms of neurodegeneration. Progressive cutaneous hyperpigmentation in a child can present as early marker of a rare neurodegenerative condition like ITS.

Published in American Journal of Pediatrics (Volume 7, Issue 3)
DOI 10.11648/j.ajp.20210703.25
Page(s) 170-173
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Infantile Tremor Syndrome, Neurodegenerative Disease, Addison’s Disease, Hypothyroidism, Inborn Error of Metabolism

References
[1] Dikshit AK. Nutritional dystrophy with anaemia. Indian J Child Health. 1957; 6: 132-6.
[2] Gupte S, Pal M, Gupta SK, Sangra KR. Infantile tremor syndrome [ITS] In: Gupte S, Editor. Textbook of paediatric nutrition. New Delhi: Peepee; 2006: 255-265.
[3] Gupte S. Infantile tremor syndrome. In: Gupte S, ed. The Short Textbook of Paediatrics, 10th ed. New Delhi; Jaypee Brothers. 2004: 716-9.
[4] Goraya JS, Kaur S, Mehra B. Neurology of nutritional vitamin B12 deficiency in infants. Case series from India and literature review. J Child Neurol. 2015; 30: 1831-1837.
[5] Korenke GC, Hunneman DH, Eber S, Hanefeld F. Severe encephalopathy with epilepsy in an infant caused by subclinical maternal pernicious anemia: case report and review of the literature. Eur J Pediatr. 2004; 163: 196-201a.
[6] Incecik F, Herguner MO, Altunbasak S, Leblebisatan G. Neurological findings of nutritional vitamin B12 deficiency in children. Turk J Pediatr. 2010; 52: 17-21.
[7] Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician 2003; 67 (5): 979-86.
[8] Jadhav M, Webb JKG, Vaishnava S, Baker SJ. Vitamin B12 deficiency in Indian infants. Lancet. 1962; 1: 903-990.
[9] Johnson PR, Roloff JS. Vitamin B12 deficiency in an infant strictly breast-fed by a mother with latent pernicious anemia. J Pediatr. 1982; 100: 917-919.
[10] Higginbottom MC, Sweetman L, Nyhan WL. A syndrome of methylmalonic aciduria, homocystinuria, megaloblastic anemia and neurologic abnormalities in a vitamin B12-deficient breast-fed infant of a strict vegetarian. N Engl J Med. 1978; 299: 317-323.
[11] Sharda B, Bhandari B. Infantile tremor syndrome. Indian Pediatr. 1987; 24: 415-421.
[12] Gilliam JN, Cox AJ. Epidermal changes in vitamin B12 deficiency. Arch Dermatol. 1973; 107: 231-6.
[13] Aaron S, Kumar S, Vijayan J, Jacob J, Alexander M, Gnanamuthu C. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency–related neurological syndromes. Neurol India 2005; 53 (1): 55-8.
[14] Demir N, Dogan M, Koc A, et al. Dermatological findings of vitamin B12 deficiency and resolving time of these symptoms. Cutan Ocul Toxicol. 2014; 33: 70-73.
[15] Sachdev KK, Manchanda SS, Lal H. The syndrome of tremors, mental regression and anemia in infants and young children. A study of 102 cases. Indian Pediatr. 1965; 2: 239-251.
[16] Pohowalla JN, Kaul KK, Bandari NR, Singh SD. Infantile “meningo- encephalitic’’ syndrome. Indian J Pediatr. 1960; 27: 49-54.
[17] Kaul KK, Prasan NG, Chowdhary RM. Further observations on the syndrome of tremors in infants. Indian Pediatr. 1964; 1: 219-225.
[18] Srikantia SG, Reddy V. Megaloblastic anemia of infancy and vitamin B12. Br J Hematol. 1967; 13: 949-953.
[19] Bajpai PC, Misra PK, Tandon PN. Further observations on infantile tremor syndrome. Indian Pediatr. 1968; 5: 297-307.
[20] Ramakumar L, Pandove SP. Infantile tremor syndrome. Indian J Pediatr. 1975; 42: 215-225.
[21] Baker SJ, Ignatius M, Johnson S, Vaish SK. Hyperpigmentation of skin. A sign of vitamin B12 deficiency. Br Med J. 1963; 1: 1713-1715.
[22] Garewal G, Narang A, Das KC. Infantile tremor syndrome: a vitamin B12 deficiency syndrome in infants. J Trop Pediatr. 1988; 34: 174-178.
[23] Goraya JS, Kaur S. Infantile tremor syndrome – downbut not out. Indian Pediatr. 2015; 52: 249–250.
[24] Rajpoot KS, Poswal L, Goyal S. Assessment of iron, folate and vitamin B12 status in children with infantile tremor syndrome. Int J Contemp Pediatr. 2016; 3: 587–592.
Cite This Article
  • APA Style

    Shivi Nijhawan, Anviti Gupta, Manisha Nijhawan, Divya Yadav, Madhu Mathur. (2021). Progressive Hyperpigmentation in a Child: An Early Marker of Infantile Tremor Syndrome. American Journal of Pediatrics, 7(3), 170-173. https://doi.org/10.11648/j.ajp.20210703.25

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    ACS Style

    Shivi Nijhawan; Anviti Gupta; Manisha Nijhawan; Divya Yadav; Madhu Mathur. Progressive Hyperpigmentation in a Child: An Early Marker of Infantile Tremor Syndrome. Am. J. Pediatr. 2021, 7(3), 170-173. doi: 10.11648/j.ajp.20210703.25

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    AMA Style

    Shivi Nijhawan, Anviti Gupta, Manisha Nijhawan, Divya Yadav, Madhu Mathur. Progressive Hyperpigmentation in a Child: An Early Marker of Infantile Tremor Syndrome. Am J Pediatr. 2021;7(3):170-173. doi: 10.11648/j.ajp.20210703.25

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  • @article{10.11648/j.ajp.20210703.25,
      author = {Shivi Nijhawan and Anviti Gupta and Manisha Nijhawan and Divya Yadav and Madhu Mathur},
      title = {Progressive Hyperpigmentation in a Child: An Early Marker of Infantile Tremor Syndrome},
      journal = {American Journal of Pediatrics},
      volume = {7},
      number = {3},
      pages = {170-173},
      doi = {10.11648/j.ajp.20210703.25},
      url = {https://doi.org/10.11648/j.ajp.20210703.25},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20210703.25},
      abstract = {Hyperpigmentary disorders are commonly encountered group of dermatoses in the paediatric age group. One of the most common causes of progressive generalised hyperpigmentation in paediatric population is nutritional vitamin B12 deficiency (NVBD). NVBD can present with a bunch of signs and symptoms like skin hyperpigmentation, pallor and regression of neurodevelopment. We report a case of a plump looking 13 months old, girl child from non-consanguineous marriage of low socioeconomic family who presented with generalised hyperpigmentation, failure to thrive and regression of mile stones. Physical examination revealed anaemia and sparse, thin, lustreless hair with dull, apathetic look. A differential diagnosis of Addison’s disease, hypothyroidism, and neurodegenerative disease, was considered based on clinical suspicion. She was further investigated by a paediatrician. Her blood investigations revealed low levels of Vitamin B12 (159 pg/dl) and haemoglobin (2.6 g/dl). On radiological examination, NCCT brain showed cortical atrophy. A final diagnosis of Infantile Tremor Syndrome (ITS) was made. ITS is a rare condition which presents with cutaneous manifestation like hyperpigmentation, scanty scalp hair along with lethargy, apathy along with signs and symptoms of neurodegeneration. Progressive cutaneous hyperpigmentation in a child can present as early marker of a rare neurodegenerative condition like ITS.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Progressive Hyperpigmentation in a Child: An Early Marker of Infantile Tremor Syndrome
    AU  - Shivi Nijhawan
    AU  - Anviti Gupta
    AU  - Manisha Nijhawan
    AU  - Divya Yadav
    AU  - Madhu Mathur
    Y1  - 2021/09/04
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajp.20210703.25
    DO  - 10.11648/j.ajp.20210703.25
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 170
    EP  - 173
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20210703.25
    AB  - Hyperpigmentary disorders are commonly encountered group of dermatoses in the paediatric age group. One of the most common causes of progressive generalised hyperpigmentation in paediatric population is nutritional vitamin B12 deficiency (NVBD). NVBD can present with a bunch of signs and symptoms like skin hyperpigmentation, pallor and regression of neurodevelopment. We report a case of a plump looking 13 months old, girl child from non-consanguineous marriage of low socioeconomic family who presented with generalised hyperpigmentation, failure to thrive and regression of mile stones. Physical examination revealed anaemia and sparse, thin, lustreless hair with dull, apathetic look. A differential diagnosis of Addison’s disease, hypothyroidism, and neurodegenerative disease, was considered based on clinical suspicion. She was further investigated by a paediatrician. Her blood investigations revealed low levels of Vitamin B12 (159 pg/dl) and haemoglobin (2.6 g/dl). On radiological examination, NCCT brain showed cortical atrophy. A final diagnosis of Infantile Tremor Syndrome (ITS) was made. ITS is a rare condition which presents with cutaneous manifestation like hyperpigmentation, scanty scalp hair along with lethargy, apathy along with signs and symptoms of neurodegeneration. Progressive cutaneous hyperpigmentation in a child can present as early marker of a rare neurodegenerative condition like ITS.
    VL  - 7
    IS  - 3
    ER  - 

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Author Information
  • Department of Dermatology, Mahatma Gandhi Medical Hospital, Jaipur, India

  • Department of Dermatology, Mahatma Gandhi Medical Hospital, Jaipur, India

  • Department of Dermatology, Mahatma Gandhi Medical Hospital, Jaipur, India

  • Department of Dermatology, Mahatma Gandhi Medical Hospital, Jaipur, India

  • Department of Paediatrics, Mahatma Gandhi Medical Hospital, Jaipur, India

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