Moreira Ana Patrícia, Vasconcelos Mafalda, Costa E Silva Teresa, Relvas Catarina, Espírito Santo João
Internal Medicine, Hospital Beatriz Ângelo, Lisboa, PRT.
Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT.
Cureus. 2024 Dec 13;16(12):e75676. doi: 10.7759/cureus.75676. eCollection 2024 Dec.
Vitamin B12 deficiency is a potentially severe condition with clinical manifestations ranging from nonspecific symptoms, such as asthenia and glossitis, to severe hematological problems, including pancytopenia and megaloblastic anemia. One of the rare phenomena associated with this condition is pseudo-thrombotic microangiopathy (pseudo-TMA), which can mimic diseases such as thrombotic thrombocytopenic purpura (TTP), leading to possible misdiagnosis and inappropriate treatment. In this article, we present the case of a 62-year-old man with a history of intravenous drug use, untreated hepatitis C, smoking, and alcoholism. The patient was admitted to the emergency department with progressive asthenia, fever, and disorientation. Laboratory findings revealed severe pancytopenia, schistocytes on the peripheral blood smear, and elevated lactate dehydrogenase levels, suggesting a microangiopathic condition. After investigation, a severe deficiency of vitamin B12 and folate was identified, and the condition was diagnosed as pseudo-TMA secondary to this deficiency. The treatment consisted of intramuscular vitamin B12 administration, resulting in the gradual normalization of the blood count and resolution of symptoms. This case highlights the importance of considering vitamin B12 deficiency in the differential diagnosis of patients with hemolytic anemia and thrombocytopenia, avoiding unnecessary interventions, such as plasmapheresis, and allowing for a quick and effective recovery with appropriate vitamin replacement.
维生素B12缺乏是一种潜在的严重病症，其临床表现范围广泛，从非特异性症状（如乏力和舌炎）到严重的血液学问题，包括全血细胞减少和巨幼细胞贫血。与这种病症相关的罕见现象之一是假性血栓性微血管病（假性TMA），它可模仿诸如血栓性血小板减少性紫癜（TTP）等疾病，导致可能的误诊和不恰当的治疗。在本文中，我们介绍了一名62岁男性的病例，该患者有静脉吸毒史、未经治疗的丙型肝炎、吸烟和酗酒史。患者因进行性乏力、发热和定向障碍被收入急诊科。实验室检查结果显示严重全血细胞减少、外周血涂片出现裂体细胞以及乳酸脱氢酶水平升高，提示存在微血管病性病症。经过检查，确定患者存在严重的维生素B12和叶酸缺乏，该病症被诊断为继发于这种缺乏的假性TMA。治疗包括肌肉注射维生素B12，结果血细胞计数逐渐恢复正常，症状得到缓解。该病例突出了在溶血性贫血和血小板减少患者的鉴别诊断中考虑维生素B12缺乏的重要性，避免进行不必要的干预（如血浆置换），并通过适当的维生素替代实现快速有效的康复。
