Would pernicious anemia present like this?

[bananas85]

I have a case that is not completely clear in outpatient.

Young fit female with a TIA like event, (facial droop), that she was admitted for with negative work up.

Also complaining of generalize fatigue some paresthesia's nothing specific.

SCreening labs showed a +ve ANA, +ds DNA.

She had low normal B12 despite eating a lot of meat so I ordered intrinsic factor and parietal cell antibody which both turned out to be positive. However no ANemia or macrocytosis.

Referred her to rheum and neuro ofcourse,

but would low normal B12 (356 range 250-1200) normal Folate 15 (range > 3) need treatment?

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[PlutoBoy]

I have a case that is not completely clear in outpatient.

Young fit female with a TIA like event, (facial droop), that she was admitted for with negative work up.

Also complaining of generalize fatigue some paresthesia's nothing specific.

SCreening labs showed a +ve ANA, +ds DNA.

She had low normal B12 despite eating a lot of meat so I ordered intrinsic factor and parietal cell antibody which both turned out to be positive. However no ANemia or macrocytosis.

Referred her to rheum and neuro ofcourse,

but would low normal B12 (356 range 250-1200) normal Folate 15 (range > 3) need treatment?

Interesting. SLE is the likely diagnosis. Antiphospholipid syndrome (lupus + TIA) is also possible. I would rule this out.

I prefer to keep B12 levels above 400 if I think B12 deficiency is playing a role.

Interesting case. Keep us posted!

 

[Anri of Astora]

She doesn't have pernicious anemia because she isn't anemic. I'm not sure if there's cross reactivity between the positive IF/parietal cell antibody with other autoimmune diseases, but you should treat the patient and not the labs. Vitamin B12 is pretty harmless and if she has non-specific paresthesias, I think worthwhile to trial some B12 supplements. But I agree with PlutoBoy - sounds like SLE/APLAB. I believe pernicious anemia is associated with other autoimmune conditions, so she may be predisposed to it, particularly with positive IF/parietal cell antibodies.

 

[drfunktacular]

I would argue that a positive ANA and dsDNA in an otherwise healthy young woman with neurological deficits is not a "negative workup".....


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[bananas85]

Sorry I didn't clarify,

What I meant was when she was admitted for TIA like symptoms the basic stroke work up was negative. they just did the standard required MRI MRI Echo and sent her home and told her to follow up with the PCP. Her deficit had resolved before she was in the ER and they probably didn't take her seriously cause she looks very health and young ofcourse.

When She came to me as a new patient, I just ordered the initial panel and that's where the ANA and ds DNA came back positive.

But when the parietal and IF antibody came back positive as well, I was just surprised by the coincidence.

 

[smartparts]

check a homocysteine and MMA level? she has parasthesias so yes she needs treatment if those are elevated.

 

[Instatewaiter]

check a homocysteine and MMA level? she has parasthesias so yes she needs treatment if those are elevated.

I'd argue if MMA were elevated with a borderline B12, then might as well treat. B12 is a relatively benign treatment. I'm not sure I would attribute B12 deficiency as the etiology for her acute neurological deficits though even were this slam dunk B12 deficiency.

OP, did workup include a TEE? Have you tested for APLS?

 

[Psai]

any followup op?