1284 PHOCOMELIA OF LEFT LOWER LEG IN AN INFANT WHOSE MOTHER TOOK LARGE DOSES OF PYRIDOXINE (B-6): ? DÉJÀ VU OF THE THALIDOMIDE DISASTER?

Abstract

This girl, now age 2½ tnos, has nearly total amelia of her left leg at the knee. There is a rudimentary foot (? just the 5th toe). X-ray shows no knee joint or tibia. Femora are normal length. Examination is otherwise normal. Pregnancy was full-term normal vaginal delivery. Birth wt 3.2+ kg. Megavitamin preparations of B-6, B-12, A, E and C were ingested by the mother, who weighs only 47 kg. At least 54 mg/day of B-6 was taken in mos 1-4 of pregnancy, and possibly more, since over-the-counter B-6 tablets are shelved together in 50, 100, 500 and 1000 mg sizes.Recent reports describe sensory neuropathy in adults with megavitaminosis B-6 (NEJMed 309:445, 1983;ibid.311:986, 1984). This neuropathy shows striking clinical similarities to that of thalidomide: stocking glove numbness first in feet and later in hands, and ataxia. A late sign with thalidomide was weakness; not yet seen in B-6. Lenz' suspicions were aroused by a woman who took thalidomide during pregnancy and developed “polyneurit-, is”, delivering a phocomelic baby. We face the same dilemma with B-6 that Lenz did when he stated in Nov. 1961: “From a scientific point of view it seems premature to discuss it [thalidomide as teratogen]. But as a human being and as a citizen, I cannot remain silent…” (see review “The Saga of Thalidomide: Neuropathy to Embryopathy”, NEJMed 267:1184 and 1238, 1962).