Kahara Toshio, Wakakuri Hitomi, Takatsuji Juri, Motoo Iori, Shima Kosuke R, Ishikura Kazuhide, Usuda Rika, Noda Yatsugi
Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama 930-8550, Japan.
Case Rep Endocrinol. 2012;2012:657156. doi: 10.1155/2012/657156. Epub 2012 Dec 13.
A 71-year-old man with diabetes mellitus visited our hospital with complaints of anorexia and weight loss (12 kg/3 months). He had megaloblastic anemia, cobalamin level was low, and autoantibody to intrinsic factor was positive. He was treated with intramuscular cyanocobalamin, and he was able to consume meals. GAD autoantibody and ICA were positive, and he was diagnosed with slowly progressive type 1 diabetes mellitus (SPIDDM). Thyroid autoantibodies were positive. According to these findings, he was diagnosed with autoimmune polyglandular syndrome type 3 with SPIDDM, pernicious anemia, and Hashimoto's thyroiditis. Extended periods of cobalamin deficiency can cause serious complications such as ataxia and dementia, and these complications may not be reversible if replacement therapy with cobalamin is delayed. Although type 1 diabetes mellitus with coexisting pernicious anemia is very rare in Japan, physicians should consider the possibility of pernicious anemia when patients with diabetes mellitus have cryptogenic anorexia with the finding of significant macrocytosis (MCV > 100 fL).
一名71岁的糖尿病男性因食欲不振和体重减轻（3个月内减轻12公斤）前来我院就诊。他患有巨幼细胞贫血，钴胺素水平低，内因子自身抗体呈阳性。他接受了肌肉注射氰钴胺治疗，之后能够正常进食。谷氨酸脱羧酶自身抗体和胰岛细胞抗体呈阳性，他被诊断为缓慢进展型1型糖尿病（SPIDDM）。甲状腺自身抗体呈阳性。根据这些检查结果，他被诊断为3型自身免疫性多腺体综合征，合并SPIDDM、恶性贫血和桥本甲状腺炎。长期钴胺素缺乏会导致严重并发症，如共济失调和痴呆，如果钴胺素替代治疗延迟，这些并发症可能无法逆转。虽然在日本，1型糖尿病合并恶性贫血的情况非常罕见，但当糖尿病患者出现原因不明的食欲不振并伴有明显大细胞增多（平均红细胞体积>100fL）时，医生应考虑恶性贫血的可能性。
