Demencia reversible por déficit de vitamina B12 en un adulto mayor / Reversible dementia caused by vitamin B12 deficiency in an older adult

Se presenta el caso de un paciente adulto mayor con antecedente de haber presentado úlcera gástrica hace 40 años, cuyos familiares observaron desde hace dos meses cambios en el comportamiento, los cuales incluyeron progresivamente desorientación, agitación psicomotriz, negativismo, delirio de persecución, lo que motivó ser traído al servicio de emergencia. Así mismo presentó palidez marcada y equimosis múltiple, por lo cual fue admitido posteriormente en nuestro servicio y diagnosticado de demencia reversible por anemia perniciosa. También se le detectó pancitopenia y cambios neurológicos. El paciente respondió favorablemente a la administración de vitamina B12.

This is the case of an elderly patient with a 40-year history of stomach ulcer, whose relatives perceived behavioral changes for the last two months. Those changes progressively included disorientation, psychomotor agitation, negativism and delirium of persecution, which caused him to be brought to the emergency room. He also showed marked pallor and multiple ecchymosis, due to which he was hospitalized in our service and diagnosed with reversible dementia caused by pernicious anemia. Pancytopenia and neurological changes were also found. The patient responded favorably to the administration of vitamin B12.

Mielopatia por deficiência de cobalamina: resolução clínica e de imagem / Cobalamin deficiency myelopathy: clinical and imaging resolution

Embora o quadro clássico de mielopatia por deficiência de vitaminaB12 seja a degeneração subaguda combinada da medula, a manifestaçãoclínica pode ser variável. Homem branco de 36 anos de idade com hipotireoidismo e vitiligo apresentou dormência nas mãos de início súbito. Exame físico: sinal de Lhermitte e hipoestesia nas palmas. Evidenciada alteração de sinal na ressonância magnética (RM) da medula cervical. Foram evidenciados nível sérico de vitamina B12 de 150 pg/mL, gastrite atrófica e hemograma normal. Paciente foi tratado com reposição intramuscular de vitamina B12. Após seis meses, houve remissão completa dos sintomas com normalização do exame de imagem em um ano. O presente caso ilustra discreta alteração clínica e lesão extensa na RM (dissociação entre a clínica e o exame de imagem) na deficiência de B12. A melhora dos sintomas precedeu a resolução da alteração no exame de imagem, no presente caso.

Although the classic manifestation of myelopathy due to vitamin B12deficiency is a subacute combined degeneration of the spinal cord, the clinical manifestation may be varied. A 36-year-old white man with hypothyroidism and vitiligo presented sudden onset of numbness in hands. Physical examination: Lhermitte's sign and hypoesthesia in palms. Signal change on magnetic resonance image (MRI) of the cervical spinal cord was evidenced. Serum vitamin B12 of 150 pg/mL, gastric atrophy and normal hemogram were shown. The patient was treated with intramuscular vitamin B12 replacement. After six months there was complete remission of the symptoms, and within one year the MRI was normal. This case illustrates mild clinical signs and extensive changes on MRI (dissociation between clinic and image) in B12 deficiency. Resolution of MRI was observed after the clinical signs, in the present case.

Oral Mecobalamin Treatment in Cobalamin Deficiency / 대한혈액학회지

BACKGROUND: The traditional treatment of cobalamin deficiency anemia is performed by intramuscular injections. However, it has been suggested that oral replacement of cobalamin is also effective as an intramuscular injection. We studied the effectiveness of oral mecobalamin treatment in patients with cobalamin deficiency. METHODS: Patients with newly diagnosed cobalamin deficiency (<200 pg/mL) or who were previously maintained on intramuscular injection were given 2,000 microgram of oral mecobalamin daily. RESULTS: Sixteen patients were enrolled. The common causes of cobalamin deficiency were total gastrectomy (75%) and pernicious anemia (12.5%). Twelve patients received oral mecobalamin, except for four patients who were lost from follow-up after initial diagnosis. The mean pretreatment values of serum cobalamin and hemoglobin level were 58.3+/-21.9pg/mL and 8.1+/-1.9g/dL, respectively. After one, two, and six months of oral therapy, the respective mean values were 1,691.8+/-260.4pg/mL, 1,085.8+/-1,110.3pg/mL and 990.2+/-249.8pg/mL of serum cobalamin, and 10.4+/-1.3g/dL, 11.3+/-2.2g/dL and 12.1+/-2.3g/dL of hemoglobin. Initially elevated serum homocysteine were normalized after one month of oral therapy. Symptoms such as glossitis were relieved rapidly by oral treatment. CONCLUSION: High-dose oral mecobalamin supplement was a simple and effective treatment in patients with cobalamin deficiency, especially in total gastrectomized patients.

A Case of Pernicious Anemia with Positive Anti Intrinsic Factor Antibody and Antiparietal Cell Antibody / 대한내과학회지

We present a case of pernicious anemia without history of operation in 52 year old female. She suffered from oral ulcer, gum bleeding, nausea, vomiting, and beefy tongue. She had dysesthesia on the both arm and foot, and hypesthesia of global and stocking type by neurologic examination. Laboratory findings were as follows: serum cobalamin 9.1 pg/mL (normal range: 180-710pg/mL), anti intrinsic factor antibody (strong positive), antiparietal cell Antibody 1:10 (positive), first stage of Schilling test (1.4%). The findings of peripheral blood and bone marrow were compatible with megaloblastic anemia. We report a case of pemicious anemia with positive anti intrinsic factor antibody and antiparietal cell antibody.