Case Report ARTICLE
Subacute combined degeneration, pernicious anemia and gastric neuroendocrine tumor occured simultaneously caused by autoimmune gastritis
- 1Qilu Hospital of Shandong University, China
- 2Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
Subacute combined degeneration (SCD) is a relatively rare myelopathy mainly caused by vitamin B12 deficiency. There are many causes contributing to vitamin B12 deficiency. Autoimmune gastritis might lead to severe vitamin B12 malabsorption and in its advanced stage pernicious anemia (PA) may occur. Besides, long-term hypergastrinemia arising from achlorhydria in autoimmune gastritis is associated with neuroendocrine tumors (NETs). Patients diagnosed with SCD coexistent with PA and NET are seldomly reported. We describe a 34-year-old woman with an initial complaint of progressively fatigue, weakness and numbness in her limbs and disturbed gait. Physical examination revealed appearance of anemia, ataxia, decrease of superficial and deep sense and positive Babinski’s sign. Laboratory tests disclosed macrocytic anemia, elevated intrinsic factor antibody and spinal MRI showed extensive T2-weighted hyperintensity in the dorsal columns. A gastric polyp was found by gastroscopy and histology showed an NET in the background of severe atrophic gastritis. Symptoms of the patient were relieved by a multidisciplinary therapy. In patients with SCD, PA should be suspected and prompt further investigations to elucidate causes and direct treatment.
Keywords: Subacute Combined Degeneration, vitamin B12 deficiency, Pernicious anemia, Autoimmune gastritis, gastric neuroendocrine tumors
Received: 26 Sep 2018;
Accepted: 03 Jan 2019.
Edited by:Leo T. Lee, University of Macau, China
Reviewed by:Nils Lambrecht, University of California, Irvine, United States
Bruno Annibale, Sapienza University of Rome, Italy
Copyright: © 2019 Wang, Zhang, Li, Ma, Shan, Li and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Dr. Xingbang Wang, Qilu Hospital of Shandong University, Jinan, China, email@example.com
Prof. Aifen Liu, Qilu Hospital of Shandong University, Jinan, China, firstname.lastname@example.org