SHM Converge Scientific Abstract ePoster Gallery-A Case of Pernicious Anemia Complicated by Gastric Carcinoid

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This case describes a 71-year-old woman who presented with four weeks of worsening generalized weakness and was found to have severe anemia, with hemoglobin of 5.1 g/dL compared with a baseline of 12 g/dL. Laboratory studies showed macrocytosis and severe vitamin B12 deficiency (B12 50 pg/mL). Positive intrinsic factor antibodies and elevated parietal cell antibodies confirmed pernicious anemia as the cause of her deficiency. She was admitted for further evaluation and managed by Hematology and Gastroenterology.<br /><br />Her anemia was associated with signs of ineffective erythropoiesis and intramedullary hemolysis, including elevated lactate dehydrogenase and bilirubin. During hospitalization, she also developed a right popliteal deep vein thrombosis, likely related to the severe hematologic abnormalities.<br /><br />An esophagogastroduodenoscopy revealed a gastric polyp, and pathology from polypectomy showed a well-differentiated grade 1 gastric neuroendocrine tumor, consistent with gastric carcinoid. Immunostaining was positive for INSM1, negative for CK7, and showed a low Ki-67 index, supporting a low-grade lesion. The tumor was attributed to chronic enterochromaffin-cell stimulation from atrophic gastritis and hypergastrinemia caused by pernicious anemia.<br /><br />The poster emphasizes that gastric carcinoid is a rare complication of pernicious anemia, occurring in approximately 1–7% of patients. Loss of parietal cells leads to reduced acid secretion, increased gastrin production, and subsequent gastric mucosal hyperplasia, raising the risk of carcinoid formation. Although these tumors are often low grade and rarely cause carcinoid syndrome, patients with pernicious anemia should undergo routine endoscopic surveillance for early detection and management.

Asset Subtitle

Benjamin Ravichander

Meta Tag

Author List Benjamin Ravichander, Irina Mishagina, Lillian Sangha, Venkataraman Rajagopalan

Category Clinical Vignettes

Concept Pernicious Anemia

Concept Vitamin B12 Deficiency

Concept Atrophic Gastritis

Concept Intrinsic Factor Antibody

Concept Macrocytic Anemia

Distinguished Non-Finalist

Presenter Organization UPMC Harrisburg

Presenting Author Benjamin Ravichander

Track Adult

Keywords

pernicious anemia

vitamin B12 deficiency

macrocytic anemia

gastric carcinoid

neuroendocrine tumor

intrinsic factor antibodies

parietal cell antibodies

hypergastrinemia

atrophic gastritis

endoscopic surveillance

Pernicious Anemia

Vitamin B12 Deficiency

Atrophic Gastritis

Intrinsic Factor Antibody

Macrocytic Anemia