Abstract
Pernicious anemia is the most common cause of vitamin B12 deficiency, being characterized by destruction of the gastric mucosa and the presence of auto-antibodies. We describe a rare case of neurogenic bladder associated with pernicious anemia. The neurologic manifestations (muscular weakness) were partially reversed with vitamin B12 replacement, but the vesical symptoms persisted. It is important to investigate the presence of vitamin B12 deficiency in cases of neurogenic bladder.DOI: http://dx.doi.org/10.3329/jom.v15i1.19883 J Medicine 2014; 15: 87-90
Highlights
Vitamin B12 deficiency frequently occurs in elderly patients, but it is not always investigated due to its mild manifestations.[1]
Pernicious anemia is the most common cause of vitamin B12 deficiency, and it is called Biermer disease, an autoimmune disease characterized by destruction of gastric mucosa and by the presence of auto-antibodies, anti-intrinsic factor and anti-gastric parietal cell1
There is no report in medical literature showing the association between rheumatoid arthritis and neurogenic bladder, so the possible cause for the vesical complication seen in our patient remains the pernicious anemia
Summary
Vitamin B12 (cobalamin) deficiency frequently occurs in elderly patients, but it is not always investigated due to its mild manifestations.[1]. Case Report A 70 years-old woman was admitted with oliguria since 60 days She referred dysuria, pelvic pain, abdominal tenderness, urinary incontinence and lower limbs decreased sensitivity. The disease progressed with paraplegy and reduction in the sense of taste and smell She had a previous diagnosis of rheumatoid arthritis, with important articular deformities (Figure 1), and she was not taking specific medications for this problem. At physical examination she was stable, with preserved consciousness. Laboratory tests at admission evidenced a macrocytic and normochromic anemia (Hb 8.26g/dL, MCV 121fL, MCH 45.2pg, MCHC 37.4g/dL), accentuated decreased vitamin B12 levels (< 100 pg/mL), increased erythrocyte sedimentation rate (52mm), positive rheumatoid factor (46 IU/mL) and normal renal function. In the 34th day of hospital stay the patient underwent a supra-pubic cystostomy and was discharged for outpatients‘ clinics follow-up
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