Vitamin B12 deficiency with combined hematological and neuropsychiatric derangements: a case report

Journal of Medical Case Reports

Alexander A Leung⁴  Rupang Pandya³  Rita Watterson¹  Luke Rannelli² 

[1] Department of Psychiatry, Foothills Medical Centre, University of Calgary, Special Services Building, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada;Department of Medicine, University of Calgary, Room 933, 9th Floor, North Tower, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada;Department of Psychiatry, University of Calgary, 1926-3500 26 Avenue NE, Calgary, AB T1Y 6J4, Canada;Department of Medicine, University of Calgary, 313-4935 40 Avenue NW, Calgary, AB T3A 2N1, Canada

关键词: Vitamin B₁₂ deficiency;    Pernicious anemia;    Pancytopenia;    Neuropsychiatric;    Megaloblastic mania;   

Others  :  1181075
DOI  :  10.1186/1752-1947-8-277

 received in 2014-04-19, accepted in 2014-07-03,  发布年份 2014

【 摘 要 】

Introduction

Although vitamin B₁₂ deficiency is a well-known cause of hematological and neuropsychiatric illness, the presentation of combined severe pancytopenia, demyelination and prominent psychiatric impairment is rare.

Case presentation

We present a case of a previously healthy 55-year-old East African man with severe vitamin B₁₂ deficiency (serum vitamin B₁₂ 22pmol/L) secondary to pernicious anemia. He had a severe hypoproliferative megaloblastic anemia with hemolysis (hemoglobin 61g/L, mean corpuscular volume 99fL, reticulocytes 0.8%, haptoglobin undetectable), leukopenia (2.7×10⁹/L), thrombocytopenia (96×10⁹/L), ataxia with central demyelination, and megaloblastic madness. The patient’s anemia, myelopathy and psychiatric condition responded well to parenteral vitamin B₁₂ replacement therapy, with significant improvement seen within weeks.

Conclusion

Hematological manifestations of vitamin B₁₂ deficiency are typically inversely correlated with the presence and severity of neuropsychiatric impairment. Although uncommon, a presentation with severe hematological and neuropsychiatric disease can occur, as illustrated by this case. Its presence may help guide diagnosis as well as provide clinically important prognostic information.

【 授权许可】

   
2014 Rannelli et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Andrès E, Loukili NH, Noel E, Kaltenbach G, Ben Abdelgheni M, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger JL, Blicklé JF: Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004, 171:251-259.
• [2]Andrès E, Affenberger S, Zimmer J, Vinzio S, Grosu D, Pistol G, Maloisel F, Weitten T, Kaltenbach G, Blicklé JF: Current hematological findings in cobalamin deficiency: a study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Haematol 2006, 28:50-56.
• [3]Stabler SP: Vitamin B12 deficiency. N Engl J Med 2013, 368:149-160.
• [4]Lindenbaum J, Healton EB, Savage DG, Brust JCM, Garrett TJ, Podell ER, Marcell PD, Stabler SP, Allen RH: Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988, 318:1720-1728.
• [5]Lindenbaum J, Rosenberg IH, Wilson PWF, Stabler SP, Allen RH: Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994, 60:2-11.
• [6]Healton EB, Savage DG, Brust JCM, Garrett TJ, Lindenbaum J: Neurologic aspects of cobalamin deficiency. Medicine 1991, 70:229-245.