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The New England Journal of Medicine Oct 2019
Topics: Anemia, Pernicious; Atrophy; Glossitis; Humans; Male; Middle Aged; Tongue
PubMed: 31618542
DOI: 10.1056/NEJMicm1902490 -
Postgraduate Medical Journal Aug 1962
Topics: Anemia; Anemia, Pernicious; Humans
PubMed: 13898413
DOI: 10.1136/pgmj.38.442.475 -
L'Encephale Dec 2015Biermer disease or pernicious anemia is an autoimmune atrophic gastritis characterized by the lack of secretion of gastric intrinsic factor. This leads to an...
Biermer disease or pernicious anemia is an autoimmune atrophic gastritis characterized by the lack of secretion of gastric intrinsic factor. This leads to an insufficient absorption of vitamin B12 in the ileum. Clinical manifestations are mainly hematologic. Neuropsychiatric manifestations are known but are less frequent especially early in the disease. Inaugural neuropsychiatric arrays are rare and various thus making diagnosis difficult. In this article, we report through two clinical cases different neuropsychiatric manifestations revealing pernicious anemia. Mrs. C.O., aged 56, presented after surgery for gallstones, an acute psychiatric array associated with gait disorders. She had no history of neurological or psychiatric problems. The psychiatric interview revealed delirious syndrome, depressive symptoms and anxiety. Neurological examination noted a flaccid paraplegia with peripheral neuropathic syndrome and myoclonus in the upper limbs. At the full blood count, a macrocytosis (VGM: 112.2fl) without anemia was found. The level of vitamin B12 in the blood was low. Cerebro-spinal MRI was suggestive of a neuro-Biermer and showed hyper signal in the cervical cord on T2-weighted sagittal section. In axial section, hyper signal appears at the posterior columns in the form of V. There were no brain abnormalities. A sensorimotor axonal polyneuropathy was diagnosed. The patient received vitamin B12 intramuscularly for ten days associated with neuroleptic treatment. Mrs. R.M., aged 40, was brought to the psychiatry consultation for acute behavioral disorders progressively worsening over a month. An anxiety syndrome, depressive syndrome and delirious syndrome were identified. Neurological examination showed a posterior cordonal syndrome with quadripyramidal syndrome. Full blood count showed a macrocytic anemia. Serum B12 level was collapsed. Cerebro-spinal MRI was normal. She received vitamin B12 with clinical and biological improvement. Features of pernicious anemia vary according to studies and age range. Digestive and hematological manifestations are well known. Neurological and psychiatric manifestations of pernicious anemia were also described in the early literature. They can be the initial symptoms or the only ones. However, inaugural neuropsychiatric features are often unrecognized. The most common psychiatric symptoms were depression, mania, psychotic symptoms, cognitive impairment and obsessive compulsive disorder. Neurological involvement includes mainly combined spinal sclerosis, peripheral neuropathy and dementia. Cerebellar ataxia and movement disorders are reported less often. Severity of neuropsychiatric features and therapeutic efficacy depends on the duration of signs and level of B12 deficiency. Macrocytic anemia may lack. Neuropsychiatric manifestations could be isolated or be the first manifestation of vitamin deficiency and occur without any hematological or gastrointestinal context. Pernicious anemia and serum B12 assay should be discussed in all patients with organic mental disorders, atypical psychiatric symptoms and fluctuation of symptomatology. Nevertheless, B12 level could be normal in genuine pernicious anemia diseases and macrocytic anemia may lack. Substitutive vitaminotherapy is required when diagnosis is strongly suspected and etiologic assessment is negative.
Topics: Adult; Anemia, Pernicious; Antipsychotic Agents; Anxiety Disorders; Delirium; Depression; Female; Gait Disorders, Neurologic; Humans; Magnetic Resonance Imaging; Middle Aged; Vitamin B 12 Deficiency
PubMed: 26345354
DOI: 10.1016/j.encep.2015.07.004 -
Scottish Medical Journal Jul 1983
Topics: Anemia, Megaloblastic; Anemia, Pernicious; DNA; Humans; Peripheral Nervous System Diseases; Vitamin B 12 Deficiency
PubMed: 6310744
DOI: 10.1177/003693308302800304 -
The American Journal of Nursing Nov 1996
Topics: Anemia, Pernicious; Humans; Nursing Assessment; Patient Care Planning; Patient Education as Topic
PubMed: 8918357
DOI: No ID Found -
The American Journal of Medicine Jul 1968
Topics: Aged; Anemia, Pernicious; Chronic Disease; Erythrocyte Count; Gastric Mucosa; Hemoglobins; Humans; Liver Extracts; Male; Spinal Cord
PubMed: 5658863
DOI: 10.1016/0002-9343(68)90014-4 -
Southern Medical Journal Mar 2004Vitamin B12 deficiency can cause profound alterations in the bone marrow. These alterations can mimic the more serious diagnosis of acute leukemia. The two patients...
Vitamin B12 deficiency can cause profound alterations in the bone marrow. These alterations can mimic the more serious diagnosis of acute leukemia. The two patients described in this report were originally suspected of having acute leukemia or myelodysplasia on the basis of the bone marrow smear, and induction chemotherapy was considered. However, after further studies, they were both found to have vitamin B12 deficiency, and parenteral vitamin B12 administration resulted in normalization of the bone marrow.
Topics: Aged; Anemia, Pernicious; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Myelodysplastic Syndromes; Vitamin B 12
PubMed: 15043340
DOI: 10.1097/01.SMJ.0000082003.98003.88 -
Autoimmunity Reviews Sep 2015Pernicious anaemia (PA) and some types of thyroid disease result from autoimmune processes. The autoimmune mechanisms in these conditions have not been fully elucidated.... (Review)
Review
Pernicious anaemia (PA) and some types of thyroid disease result from autoimmune processes. The autoimmune mechanisms in these conditions have not been fully elucidated. This review discusses the autoimmune mechanisms involved in PA and how these affect diagnosis and disease progression. In addition to gastric antibodies, antibodies to the vitamin B12 binding protein transcobalamin which can result in high serum B12 levels are also addressed with regard to how they affect clinical practice. The role of autoimmune susceptibility is investigated by comparing PA to one of its most common comorbidities, autoimmune thyroid disease (AITD). Thyroid disease (although not exclusively AITD) and B12 deficiency are both also implicated in the pathology of hyperhomocysteinemia, an elevated homocysteine in plasma. Since hyperhomocysteinemia is a risk factor for cardiovascular occlusive disease, this review also addresses how thyroid disease in particular leads to changes in homocysteine levels.
Topics: Anemia, Pernicious; Animals; Antibodies; Autoimmunity; Helicobacter Infections; Humans; Risk Factors; Thyroid Diseases
PubMed: 25936607
DOI: 10.1016/j.autrev.2015.04.011 -
Clinical Pharmacology and Therapeutics 1966
Topics: Anemia, Pernicious; Female; History, 20th Century; Pregnancy; United States; Vitamin B 12
PubMed: 5327177
DOI: 10.1002/cpt196672147 -
Journal of Diabetes and Its... 2009A 27-year-old male, who had developed diabetes mellitus type 1 (DMT1) since the age of eighteen and alopecia areata universalis nine months later, attended the...
A 27-year-old male, who had developed diabetes mellitus type 1 (DMT1) since the age of eighteen and alopecia areata universalis nine months later, attended the outpatient clinics complaining of general fatigue and shortness of breath. A Schilling test was indicative of pernicious anemia. Antigastric parietal cell (AGPA) and anti-intrinsic factor antibodies were positive, confirming diagnosis of pernicious anemia. Thyroid and Addison's disease were excluded. Gastroscopy revealed atrophic gastritis without any evidence of carcinoid tumors. The aim of this case, which, to our knowledge, is the first one to describe a correlation between diabetes mellitus Type 1 (DMT1), pernicious anaemia, and alopecia areata universalis, is to remind the clinician of the increased risk of pernicious anaemia and gastric carcinoids in DMT1 patients. Screening for AGPA followed by serum gastrin and vitamin B(12) levels constitute the most evidence-based diagnostic approach.
Topics: Adult; Alopecia Areata; Anemia, Pernicious; Autoantibodies; Diabetes Mellitus, Type 1; Gastric Mucosa; Humans; Intrinsic Factor; Male; Parietal Cells, Gastric
PubMed: 18614380
DOI: 10.1016/j.jdiacomp.2008.05.003