SHM Converge Scientific Abstract ePoster Gallery-Paraplegia With Venous Thrombosis Masquerading as Vitamin B12 Deficiency: An Unfortunate Sequelae of Undiagnosed Pernicious Anemia

Pdf Summary

This case report describes a 32-year-old man whose progressive weakness, cognitive decline, urinary retention, and respiratory failure were initially suggestive of a severe neurologic disorder. He was found to have flaccid paraplegia, megaloblastic anemia, diaphragm weakness, and acute hypercapnic respiratory failure requiring ICU admission and mechanical ventilation.<br /><br />Initial imaging and cerebrospinal fluid studies did not support infection, but later MRI findings showed demyelination along the corticospinal tracts, consistent with subacute combined degeneration of the spinal cord. Laboratory testing revealed undetectable vitamin B12 levels, elevated methylmalonic acid and homocysteine, and positive intrinsic factor antibodies. Upper endoscopy confirmed autoimmune atrophic gastritis, establishing the diagnosis of pernicious anemia as the cause of the B12 deficiency.<br /><br />During evaluation, he was also found to have extensive left leg deep vein thrombosis and bilateral pulmonary emboli. The authors suggest these thrombotic events were likely multifactorial, related to prolonged immobilization from paraplegia and possible hypercoagulability from hyperhomocysteinemia due to B12 deficiency.<br /><br />Treatment included immediate intramuscular vitamin B12 replacement, full anticoagulation, ventilatory support, bladder decompression, and rehabilitation. He improved enough to be weaned from mechanical ventilation, but continued to have residual paraplegia requiring acute rehabilitation.<br /><br />The discussion emphasizes that vitamin B12 deficiency should be considered in patients with ascending weakness or neurologic deficits, especially because delayed diagnosis can lead to irreversible spinal cord damage. In pernicious anemia, lifelong B12 supplementation and surveillance are needed due to risks of gastric malignancy and other autoimmune disease. The case also highlights the importance of recognizing the possible thrombotic complications of severe B12 deficiency and treating both the deficiency and any associated thrombosis promptly.

Asset Subtitle

Ijeoma v. Aneke

Meta Tag

Author List Farideh Zonouzi-Zadeh MD, Ijeoma v. Aneke, Sara J. Guevara

Category Clinical Vignettes

Concept Vitamin B12 Deficiency

Concept Pernicious Anemia

Concept Subacute Combined Degeneration

Concept Demyelination

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Ijeoma v. Aneke

Track Adult

Keywords

vitamin B12 deficiency

pernicious anemia

subacute combined degeneration

demyelination

hyperhomocysteinemia

deep vein thrombosis

pulmonary embolism

megaloblastic anemia

respiratory failure

intrinsic factor antibodies

Vitamin B12 Deficiency

Pernicious Anemia

Subacute Combined Degeneration

Demyelination

Neurologic Deficit