Lavoie Matthew R, Cohen Nicolette C, Gregory Timothy A, Weber Peter V
Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.
Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
BMJ Case Rep. 2020 Mar 24;13(3):e234276. doi: 10.1136/bcr-2020-234276.
Vitamin B deficiency can be caused by a diverse group of aetiologies. One of the less common of these is an autoimmune condition pernicious anaemia, so named after the most common physiological manifestation of B deficiency: anaemia. However, B is also necessary for nervous system function and its depletion can lead to dysfunction of the posterior columns of the spinal cord resulting in subacute combined degeneration (SCD). This disease, while debilitating in its acute phase, can usually be mostly if not fully reversed if caught early and treated appropriately. Early detection can prove challenging if there are no haematological manifestations of B deficiency and the only guidance is the high index of suspicion. We present a case of pernicious anaemia leading to SCD without any clinical or laboratory findings of anaemia in this report.
维生素B缺乏可由多种病因引起。其中较不常见的一种是自身免疫性疾病——恶性贫血，它因维生素B缺乏最常见的生理表现——贫血而得名。然而，维生素B对神经系统功能也很必要，其缺乏会导致脊髓后柱功能障碍，进而引发亚急性联合变性（SCD）。这种疾病在急性期会使人衰弱，但如果早期发现并得到适当治疗，通常即使不能完全逆转，也大多可以得到改善。如果没有维生素B缺乏的血液学表现，且唯一的指导是高度怀疑指数，那么早期检测可能具有挑战性。在本报告中，我们介绍了一例恶性贫血导致SCD但无任何贫血临床或实验室检查结果的病例。
