Anemia perniciosa y atrofia gástrica / Pernicious anemia and gastric athropy

RESUMEN

Varón de 84 años agricultor, diagnosticado el 2001 de anemia megaloblástica asociada a deficiencia de vitamina B12, polineuropatía sensitivo-motora en miembros inferiores y atrofia gástrica (AG) con metaplasia intestinal. Fue tratado con combinaciones de ácido fólico 1000 mcg y cianocobalamina 8mcg, mejora y normaliza cifras de hemoglobina trás 2 meses de terapia. Un año después, abandona el tratamiento, por sentirse mejor. La anemia y la signología de polineuropatía sensitivo motora con inadecuada percepción gustativa de los sabores normales reaparecen el 2008. Por esta época los estudios demuestran pancitopenia, anemia megaloblástica severa, deficiencia de Vit B12, atrofia gástrica, pólipos y xantomas en la superficie gástrica, metaplasia intestinal, alteraciones de lípidos séricos, xerosis facial y máculas blancas (2-3 mm) generalizadas. Recibió tratamiento con cianocobalamina parenteral, el paciente persiste (2012) con su AG, aunque la polineuropatía sensitivo-motora desapareció y sus niveles de hemoglobina son normales.

ABSTRACT

We present the case of an 84-year old male farmer, who was diagnosed in 2001 with megaloblastic anemia associated to vitamin B12 deficiency, sensory-motor polyneuropathy in his lower limbs and gastric atrophy with intestinal metaplasia. The patient was tr eated with a combination including 1000 mcg folic acid and 8 mcg cyanocobalamin. He impr oved his hemoglobin levels back to normal after 2 months of therapy. One year later, he stooped therapy because he was feeling better. In 2008, anemia and the sensorial motor polyneuropathy reappeared, together with an inadequate perception of normal flavor. At this time studies showed the following pancytopenia, severe megaloblastic anemia, vitamin B12 deficiency, gastric atrophy, gastric polyps and xanthomas, intestinal metaplasia, serum lipid abnormalities, facial xerosis and generalized white spotted macular lesions (2-3 mm). He was treated with parenteral cyanocobalamin, and the patient now still has gastric atr ophy, although the sensorial-motor polyneuropathy had disappeared and his hemoglobin levels are once again normal.