Macrocytic anemia with Paraplegia due to Tuberculosis - Case Report

Abstract

Vitamin B12 deficiency can result in macrocytic anemia. There are various neurologic abnormalities associated with vitamin B12 deficiency. Segmental involvement of the distal ileum, like tuberculosis, could cause vitamin B12 deficiency.
Case presentation: A 16-year-old girl had presented with complaints of paraplegia, ataxia, fever and fatigue that had started a few months earlier and which had been getting worse in the last three weeks. Her laboratory results were indicative of macrocytic anemia with a serum vitamin B12 level <90 pg/ml and hyper-segmented neutrophils. Her MRI findings revealed brain atrophy. Her fever eventually led to the diagnosis of tuberculosis which was documented by bone marrow aspiration smear & culture. A small bowel series showed that tuberculosis had typically involved the terminal ileum which had resulted in vitamin B12 deficiency. She was treated for vitamin B12 deficiency and tuberculosis. Her fever ceased and her hemoglobin level returned to normal. Vitamin B12 deficiency should be considered in patients with neurologic features such as paresthesia, sensory deficits, urinary incontinence, dysarthria, and ataxia. The fundamental cause of B12 deficiency should be determined and treated to prevent the patients' need for long term vitamin B12 therapy.