Refractory Megaloblastic Anemia Associated with Excretion of Orotic Acid

Abstract

A megaloblastic anemia in a child with hypochromic, microcytic erythrocytes was resistant to vitamin B12, folic iron and pyridoxine. Improvement followed the administration of adrenal steroid hormones, and a complete hematologic remission followed the addition of a crude mixture containing uridylic acid and cytidylic acid. During the relapse, large amounts of orotic acid were excreted in the urine. Death followed an attack of varicella.