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

Luke Rannelli,Rita Watterson,Rupang Pandya,Alexander A Leung

doi:10.1186/1752-1947-8-277

Abstract

IntroductionAlthough 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 presentationWe 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.ConclusionHematological 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.

Highlights

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 secondary to pernicious anemia
Hematological manifestations of vitamin B12 deficiency are typically inversely correlated with the presence and severity of neuropsychiatric impairment
We describe an unusual case of a patient with severe vitamin B12 deficiency together with profound hematological derangements and florid neuropsychiatric impairment

Summary

Conclusion

Pernicious anemia can present with severe hematologic and neuropsychiatric conditions concurrently, contrary to stated dogma. Appropriate therapy can lead to complete recovery in up to two-thirds of patients treated [2,3]. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions LR, RW and AL were involved in drafting, writing and editing the manuscript. RP contributed to the writing and editing of the manuscript. All authors were directly involved in the care of the patient. All authors read and approved the final manuscript

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