Biotin Deficiency Complicating Parenteral Alimentation

Abstract

To the Editor.— The article entitled Biotin Deficiency in an Adult During Home Parenteral Nutrition by McClain et al (1982;247:3116) did not accurately characterize our previous publication describing the first documented case of biotin deficiency during parenteral alimentation 1 and did not document biotin deficiency in the patient described. In reference to our report, McClain and colleagues stated that these investigators presumed this represented a case of acquired biotin deficiency, but could not rule out the possibility of an unrecognized inborn error of metabolism, especially in light of the high doses of biotin administered. In our patient, frank biotin deficiency was clearly documented both by reduced plasma concentration of biotin and reduced urinary excretion of biotin, and by demonstration of urinary organic acid excretion diagnostic of deficiency of multiple biotin-dependent enzymes. Ample evidence was presented in the same report that the patient did not have an inborn error of biotin