Manifestations of Vitamin Deficiency during Aureomycin and Chloramphenicol Therapy of Endocarditis due to Staphylococcus Aureus *

A number of side effects have been noted during aureomycin and chloramphenicol therapy. Harris' described the untoward effects in detail and suggested that many of these are caused by an interference with the biochemical processes involved in vitamin B metabolism. In addition to the gastrointestinal symptoms of nausea and/or vomiting, epigastric distress, heartburn, and diarrhea, he noted that the stools often became odorless or nearly so in association with a change in the normal intestinal bacterial flora. Mucous membrane manifestations which closely resembled those of pronounced riboflavin deficiency were also seen. Orally administered vitamin B complex did not prevent these lesions. Parenteral administration of a potent preparation of vitamin B complex was more effective in preventing and reversing them. Harris considered these lesions to be due to the destruction of the intestinal bacteria necessary for the synthesis or utilization of members of the B complex. Several of Harris' patients also developed lesions of the skin and mucous membranes of the perineal region. Candida albicans was isolated from these areas, and it was suggested that overgrowth of this fungus following the destruction of the normal intestinal bacterial flora by aureomycin or chloramphenicol might lead to the development of virulent strains capable of invading more vital tissues. Abnormal bleeding tendencies of minor degree consisting of slight vaginal bleeding in three patients, rectal bleeding in another three patients, and subungual hemorrhage in one patient were also noted by Harris. No special studies to determine the mechanism were made, but vitamin K deficiency was suspected in retrospect. The following case is noteworthy because it not only illustrates many of the side effects previously described, but it also demonstrates the occurrence of a peripheral neuritis, an optic neuritis, and severe gastrointestinal bleeding associated with prothrombin deficiency and roentgenographic changes in the intestinal mucosa.