A Pediatric Case of Severe Vitamin B12 Deficiency Presenting as Transaminitis

The classic findings of vitamin B12 deficiency include anemia and neurologic symptoms. Elevation of liver enzymes is an atypical finding of this deficiency. In this case report, we present a ten-year-old male with pancytopenia due to vitamin B12 deficiency which was associated with elevated transaminases. Extensive work-up was completed to find a cause for this transaminitis with unremarkable results. Liver enzyme levels normalized with aggressive intramuscular vitamin B12 supplementation, suggesting a direct correlation.