SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Vitamin B12 Deficiency: Lessons Learned

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This case report describes a 23-year-old man who developed progressive bilateral arm paresthesia, fatigue, neck pain, and Lhermitte’s sign over several weeks. Early evaluations focused on musculoskeletal and spinal causes because cervical MRI showed mild degenerative changes. He was initially diagnosed with radiculopathies and advised conservative management. However, as symptoms worsened, further imaging of the thoracic/lumbar spine and brain was normal, prompting a broader neurologic and laboratory workup.<br /><br />Blood testing revealed low vitamin B12 (200 pg/mL) with markedly elevated methylmalonic acid, confirming B12 deficiency despite normal red blood cell counts, hemoglobin, and hematocrit. After extensive evaluation for infectious, inflammatory, autoimmune, and toxic causes, the diagnosis of cobalamin deficiency was made. The patient was treated with high-dose oral B12 and a course of subcutaneous B12 injections. His symptoms gradually improved, and he was symptom-free 10 months later; B12 levels normalized significantly.<br /><br />The report emphasizes that vitamin B12 deficiency can present without anemia and with nonspecific neurologic symptoms, making diagnosis challenging. It warns against over-reliance on spinal imaging, since degenerative findings are common even in asymptomatic young adults and may distract clinicians from the true cause. The authors stress that delayed recognition of B12 deficiency can lead to irreversible spinal cord injury. They recommend increased awareness of early neurologic signs and suggest routine B12 screening in vegetarians, including those who consume dairy or eggs.

Asset Subtitle

Naisarg B. Vanani

Meta Tag

Author List Ashin Mehta, Naisarg B. Vanani, Pinky Jha, Whitney Lynch

Category Clinical Vignettes

Concept Vitamin B12

Concept Vitamin B12 Deficiency

Concept Neurologic Symptoms

Concept Methylmalonic Acid

Concept Serum Vitamin B12 Test

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Naisarg B. Vanani

Track Adult

Keywords

vitamin B12 deficiency

cobalamin deficiency

paresthesia

Lhermitte sign

methylmalonic acid

neurologic symptoms

spinal imaging

anemia-free B12 deficiency

vegetarian screening

subacute combined degeneration

Vitamin B12

Vitamin B12 Deficiency

Neurologic Symptoms

Methylmalonic Acid

Serum Vitamin B12 Test