Case Report : Uncommon presentation of pernicious anemia, hypothyroidism, and pericardial effusion

Abstract

Introduction: Pernicious anemia is not commonly investigated as an etiology for Vitamin B12 deficiency. However, it is associated with other autoimmune disorders and may be linked with H. pylori infections as well as an increased risk of gastric cancers. Case Presentation: The patient was a 42 year old male patient who presented with hemoglobin of 4.5, MCV of 133.3, and pancytopenia. His symptoms at admission were dyspnea and peripheral neuropathy. His past medical history was significant for hypothyroidism and plaque psoriasis. The patient was found to have low serum vitamin B 12 with positive parietal cell antibodies. Echocardiogram revealed a stable pericardial effusion. He was administered one unit of packed red blood cells, parenteral cobalamin, and oral levothyroxine. He clinically improved with conservative management.Conclusion: This case highlights the constellation of signs, symptoms, laboratory findings, and imaging that can be seen with pernicious anemia, and it also discusses management. It is important for the patient to undergo proper workup of the autoimmune conditions associated with pernicious anemia when appropriate.