Abstract
Subacute combined degeneration (SCD) is a relatively rare myelopathy mainly caused by vitamin B12 (VitB12) deficiency. There are many causes contributing to VitB12 deficiency. Autoimmune gastritis might lead to severe VitB12 malabsorption and in its advanced stage pernicious anemia (PA) may occur. Besides, long-term hypergastrinemia arising from achlorhydria in autoimmune gastritis is associated with neuroendocrine tumors (NETs). Patients diagnosed with SCD coexistent with PA and NET are seldomly reported. We describe a 34-year-old woman with an initial complaint of progressive fatigue, weakness and numbness in her limbs and disturbed gait. Physical examination revealed appearance of anemia, ataxia, decrease of superficial and deep sense, and positive Babinski’s sign. Laboratory tests disclosed macrocytic anemia, elevated intrinsic factor antibody and spinal MRI showed extensive T2-weighted hyperintensity in the dorsal columns. A gastric polyp was revealed by gastroscopy and histology showed an NET in the background of severe atrophic gastritis. Symptoms of the patient were relieved by a multidisciplinary therapy. In patients with SCD, PA should be suspected and prompt further investigations to elucidate causes and direct treatment.
Highlights
Subacute combined degeneration (SCD) is an uncommon kind of myelopathy
We describe a 34-year-old female who developed SCD, pernicious anemia (PA) and gastric neuroendocrine tumors (NETs) which is related to autoimmune gastritis
Only testing vitamin B12 (VitB12) is not enough since VitB12 deficiency can be caused by low dietary intake, malabsorption, gastric and intestinal surgery, inherited disorders and medications (Stabler, 2013)
Summary
Subacute combined degeneration (SCD) is an uncommon kind of myelopathy. It is characterized by demyelination of the lateral and dorsal columns of the spinal cord. The presence of coexisting SCD, PA and gastric NET is rare in young patients, and they have normal diet without history of gastrointestinal surgery. We describe a 34-year-old female who developed SCD, PA and gastric NET which is related to autoimmune gastritis. In the previous 20 days, the patient couldn’t walk or stand up, and she experienced palpitations and shortness of breath She has a history of vitiligo dating back more than 5 years. Other significant laboratory results revealed a remarkably reduced level of VitB12 (
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