Haddad Fouad, Boukhal Zineb, El Rhaoussi Fatima Zahra, Tahiri Mohamed, Hliwa Wafaa, Bellabah Ahmed, Wafaa Badre
Gastroenterology and Hepatology, Ibn Rochd University Hospital Center, Casablanca, MAR.
Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, MAR.
Cureus. 2024 Apr 19;16(4):e58601. doi: 10.7759/cureus.58601. eCollection 2024 Apr.
Biermer's disease (BD) or pernicious anemia (PA) is an autoimmune atrophic gastritis characterized by the absence of intrinsic factor (IF) secretion, leading to malabsorption of vitamin B12 in the ileum. Its clinical manifestations are primarily hematological, with neuropsychiatric and cardiovascular manifestations being less common. We present the case of a patient with PA diagnosed based on neurological and cardiovascular complications. The patient, a 56-year-old man with no specific medical history, presented with an episode of melena without other associated digestive symptoms. He also complained of memory and gait disturbances. Clinical examination revealed a cerebellar ataxia with impaired proprioceptive and vibratory sensitivity, and a swollen and red right lower limb with a positive Homan sign. The blood count showed macrocytic anemia. Gastroscopy revealed flattened fundic folds resembling a fundus appearance, and histopathological examination confirmed fundic atrophic gastritis with pseudopyloric metaplasia and lymphoplasmacytic infiltration. Anti-intrinsic factor antibodies were positive, while anti-parietal cell antibodies were negative. Vitamin B12 levels were severely low, and vitamin B9 levels were normal. TSH and HbA1c levels were within normal ranges. The abdominal CT scan showed no abnormalities. Lower limb Doppler ultrasound confirmed the diagnosis of deep vein thrombosis (DVT). Cardiac evaluation revealed sinus bradycardia suggestive of secondary dysautonomia. Therapeutically, the patient was started on vitamin B12 supplementation and anticoagulant therapy for DVT, resulting in a good clinical and biological outcome.
比尔默病（BD）或恶性贫血（PA）是一种自身免疫性萎缩性胃炎，其特征是缺乏内因子（IF）分泌，导致回肠对维生素B12吸收不良。其临床表现主要为血液学方面的，神经精神和心血管方面的表现较少见。我们报告一例基于神经和心血管并发症诊断为PA的患者。该患者为一名56岁男性，无特殊病史，出现一次黑便，无其他相关消化系统症状。他还主诉有记忆和步态障碍。临床检查发现小脑共济失调，本体感觉和振动觉减退，右下肢肿胀、发红，霍曼征阳性。血常规显示大细胞性贫血。胃镜检查发现胃底皱襞变平，类似胃底外观，组织病理学检查证实为胃底萎缩性胃炎伴假幽门化生和淋巴浆细胞浸润。抗内因子抗体阳性，而抗壁细胞抗体阴性。维生素B12水平严重偏低，维生素B9水平正常。促甲状腺激素和糖化血红蛋白水平在正常范围内。腹部CT扫描未发现异常。下肢多普勒超声证实诊断为深静脉血栓形成（DVT）。心脏评估显示窦性心动过缓，提示继发性自主神经功能障碍。治疗上，患者开始补充维生素B12并接受针对DVT的抗凝治疗，取得了良好的临床和生物学效果。
