Recognizing Subacute Combined Degeneration in Patients With Normal Vitamin B12 Levels.

• Type of Material: Article
• Authors: Brianna Burlock, Emory University; Jason Williams, Emory University
• Language: English
• Date: 2021-06
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © 2021, Burlock et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.15429
• Title of Journal or Parent Work: Cureus
• Volume: 13
• Issue: 6
• Start Page: e15429
• End Page: e15429
• Keywords: subacute combined degeneration; serum vitamin b12; methylmalonic acid; pernicious-anemia; cobalamin deficiency
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Vitamin B12 deficiency is commonly associated with dementia in patients over the age of 65 years; however, it can affect people of all ages. Recognizing the clinical sequelae of subacute combined degeneration is essential for the timely diagnosis and treatment of vitamin B12 deficiency. In this report, we describe a case of a young man presenting with several months of neuropathy, depression, and abdominal symptoms. His initial vitamin B12 levels were within normal limits, but an elevated methylmalonic acid level and subacute combined degeneration of his spine on MRI confirmed the diagnosis of vitamin B12 deficiency. The patient later tested positive for autoantibodies associated with pernicious anemia. His symptoms improved with intramuscular injections of cyanocobalamin. This case highlights the importance of recognizing vitamin B12 deficiency in patients of all age groups even in the setting of apparently "normal" B12 levels.