hydroxocobalamin and Gastritis--Atrophic

Topics: Anemia, Pernicious; Female; Folic Acid Deficiency; Gastritis, Atrophic; Homocysteine; Humans; Hydroxocobalamin; Methylmalonic Acid; Middle Aged; Tetrahydrofolates; Vitamin B 12; Vitamin B Complex

Pernicious anemia is a megaloblastic anemia caused by vitamin B12 deficiency, and is the end-stage of autoimmune gastritis that typically affects persons older than 60 years. It is the most common cause of vitamin B12 deficiency. Pernicious anemia can also be diagnosed concurrently with other autoimmune diseases. We report the occurrence of megaloblastic anemia in a 22-year-old woman with chronic autoimmune thyroiditis for 10.5 years. Recently, she presented with microcytic anemia, and iron deficiency anemia was diagnosed initially. After administration of ferrous sulfate, macrocytic anemia was revealed and vitamin B12 deficiency was detected. Pernicious anemia was highly suspected because of the endoscopic finding of atrophic gastritis, and high titer of antigastric parietal cell antibody, as well as elevated serum gastrin level. After intramuscular injections of hydroxycobalamine 100 microg daily for 10 days, and monthly later, her blood counts returned to normal.

Topics: Adult; Anemia, Iron-Deficiency; Anemia, Pernicious; Female; Ferrous Compounds; Gastritis, Atrophic; Hashimoto Disease; Hematinics; Humans; Hydroxocobalamin; Vitamin B 12 Deficiency

In chronic atrophic gastritis atrophy of the stomach glands leads to intrinsic factor deficit, with consequent failure to absorb vitamin B12 and gastric achylia, which predisposes to Giardia infection which in itself leads to depletion of vitamin B12. We describe the case of a patient with peripheral and central nervous system pathology due to lack of vitamin B12 secondary to the combined effect of these two disorders.. A 54 year old woman consulted us for paraesthesia and weakness of the legs which had been progressive for the previous two years. She presented with tactile hypoaesthesia, hypoparaesthesia, distal hyperreflexia and dysymmetry of the legs, ataxic-spastic gait and a positive Romberg sign. The investigations carried out showed the serum vitamin B12 level to be 3 pg/ml (N: 180-900), hemoglobin 13 g/dl and MCV 111 fl with MCHC 348/dl; neurophysiological studies: compatible with demyelinating motor polyneuropathy. Schilling test: deficit of absorption of vitamin B12 which was corrected on administration of intrinsic factor; gastroscopy; atrophic gastritis which confirmed the morbid anatomy findings. There was also flora containing Helicobacter and massive Giardia infection. Replacement and antibiotic therapy was followed by complete remission of the clinical picture.. We emphasize the excellent clinical response to treatment in spite of the time elapsed since onset of symptoms.

Topics: Amoxicillin; Anemia, Pernicious; Anti-Bacterial Agents; Antiprotozoal Agents; Bismuth; Duodenitis; Enzyme Inhibitors; Evoked Potentials, Somatosensory; Female; Gastritis, Atrophic; Giardiasis; Helicobacter Infections; Helicobacter pylori; Humans; Hydroxocobalamin; Malabsorption Syndromes; Metronidazole; Middle Aged; Neural Conduction; Omeprazole; Peripheral Nervous System Diseases; Remission Induction; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Cortisone; Diseases in Twins; Female; Follow-Up Studies; Gastritis, Atrophic; Humans; Hydroxocobalamin; Middle Aged; Ranitidine; Remission, Spontaneous; Time Factors; Twins, Monozygotic