A Case Report of Pernicious Anemia and Recurrent Aphthous Stomatitis

2009 ◽  
Vol 10 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Ricardo Alves Mesquita ◽  
Bruna Gonçalves Garcia ◽  
Marcelo Ferreira Pinto Cardoso ◽  
Omar de Faria ◽  
Ricardo Santiago Gomez
Keyword(s):  
Folic Acid ◽  
Case Report ◽  
Vitamin B12 ◽  
Pernicious Anemia ◽  
Systemic Disease ◽  
Intrinsic Factor ◽  
Serum Vitamin ◽  
Recurrent Aphthous Stomatitis ◽  
Aphthous Stomatitis ◽  
Vitamin B12 Malabsorption

Abstract Aim The aim of this report is to present the management of a patient with pernicious anemia afflicted with recurrent aphthous stomatitis (RAS). Background RAS is one of the most common lesions of the oral mucosa. Although the exact etiology of RAS is still unknown different hematinic deficiencies have been proposed. Case Report Painful recurrent ulcers covered with a grayish pseudomembrane surrounded by an erythematous margin were identified on the tongue and in the buccal mucosa of a 71-year-old woman. The patient also presented with depapilation of the tongue. The clinical diagnosis was RAS. Laboratory tests including a hemogram were ordered to determine existing levels of folic acid, iron, ferritin, and vitamins B2, B6, and B12. Levels of serum vitamin B12 and serum hemoglobin were low. The laboratory investigation also showed a medium corpuscular volume of 104.1 fl. A gastroduodenoscopy revealed no macroscopic abnormality. A gastric biopsy showed mucosal atrophy in the gastric corpus with evidence of intestinal metaplasia. Antibodies against an intrinsic factor were negative. The diagnosis pernicious anemia was made, with RAS caused by vitamin B12 malabsorption. Treatment consisted of the administration of 1.0 ml of hydroxocolabamin intramuscularly twice weekly over four weeks followed by 1.0 ml once weekly for four weeks. Clinical resolution was observed after two months. Summary The association of RAS with vitamin B12 malabsorption is a rare event. However, along with conventional RAS clinical management, iron, folic acid, vitamin B deficiencies, and nutritional intolerance must be considered. Evaluation of the predisposing factors is imperative in treating patients with RAS including vitamin B12 malabsorption. Clinical Significance Determination of the levels of vitamin B12 should be the basis for replacement therapy. Such therapy can be considered a benefit to the patients with RAS as its etiology remains unclear. Clinicians must be alert to the possibility this lesion could be a signal of systemic disease. Citation Garcia BG, Cardoso MFP, Faria O, Gomez RS, Mesquita RA. A Case Report of Pernicious Anemia and Recurrent Aphthous Stomatitis. J Contemp Dent Pract 2009 March; (10)2:083-089.

scholarly journals Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review

2019 ◽  
pp. 93-103
Author(s):  
Yadira V. Boza Oreamuno DDS, MSc ◽  
María F. Rugama Flores BSND
Keyword(s):  
Folic Acid ◽  
Iron Deficiency ◽  
Vitamin B12 ◽  
Systemic Disease ◽  
Recurrent Aphthous Stomatitis ◽  
Blood Analysis ◽  
Aphthous Stomatitis ◽  
Vegan Diet ◽  
Nutritional Deficiencies ◽  
First Case

Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year-old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.

scholarly journals Vitamin B12 Malabsorption Due to Intrinsic Factor Deficiency in Indian Subjects

Blood ◽  
1972 ◽  
Vol 40 (5) ◽  
pp. 747-753 ◽  
Author(s):  
H. G. Desai ◽  
F. P. Antia
Keyword(s):  
Vitamin B12 ◽  
Pernicious Anemia ◽  
Indian Population ◽  
Intrinsic Factor ◽  
Subacute Combined Degeneration ◽  
Factor Deficiency ◽  
Vitamin B12 Absorption ◽  
Intrinsic Factor Deficiency ◽  
Intrinsic Factor Antibody ◽  
Vitamin B12 Malabsorption

Abstract Sixteen patients (from Bombay) with severe vitamin B12 malabsorption due to intrinsic factor deficiency, presenting as subacute combined degeneration of the cord (7), tropical sprue (3), anemia (2), thyrotoxicosis (2), diabetes mellitus (1), and pain in the abdomen (1), are reported. The difficulties of establishing a definite diagnosis of pernicious anemia in Indian population are described. The lower incidence of circulating intrinsic factor antibody (IFA) in Indian patients with histamine-fast achlorhydria and poor vitamin B12 absorption is emphasized. The necessity of separating atrophic gastritis, with severely impaired vitamm B12 absorption, from pernicious anemia on the basis of absence or presence of IFA in serum and/or gastric juice cannot be overemphasized.

scholarly journals Serum vitamin B12 associated with vitamin D/25(OH)D in women with recurrent aphthous stomatitis.

2020 ◽  
Vol 9 (1) ◽  
pp. 21-28
Author(s):  
Hendri Susanto ◽  
◽  
Puput Kendarwati ◽  
Sri Budiarti ◽  
Supriatno . ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin B12 ◽  
Serum Vitamin ◽  
Recurrent Aphthous Stomatitis ◽  
Aphthous Stomatitis

Semiautomated system for simultaneous assays of serum vitamin B12 and folic acid in serum evaluated.

1982 ◽  
Vol 28 (10) ◽  
pp. 2161-2165 ◽  
Author(s):  
I W Chen ◽  
E B Silberstein ◽  
H R Maxon ◽  
C P Volle ◽  
B H Sohnlein
Keyword(s):  
Folic Acid ◽  
Vitamin B12 ◽  
Data Reduction ◽  
Intrinsic Factor ◽  
Serum Vitamin ◽  
Nonspecific Binding ◽  
Becton Dickinson ◽  
Simultaneous Measurements ◽  
On Line ◽  
Automated Process

Abstract We evaluated performance characteristics of a semiautomated radioassay system (ARIA II, Becton Dickinson Immunodiagnostics) for simultaneous measurements of vitamin B12 and folic acid in serum. The system requires off-line boiling of samples, which are then processed on-line. The automated process includes dispensing of boiled samples, tracers, and binders (purified intrinsic factor and milk binder); incubation, separation of bound and free ligands; elution; counting radioactivity of 57Co and 125I; and data reduction. Results were compared with those obtained by a manual method (Diagnostic Products Corp.). Although the nonspecific binding of the ARIA II is more than double that of the manual system, the precision values are comparable (within- and between-assay CVs are less than 8.5%). Values obtained with these two systems correlated well except that folic acid concentrations obtained with ARIA II tended to be lower at high folic acid concentrations. We observed no significant total carryover or drift in the semiautomated system.

Significant association of deficiencies of hemoglobin, iron, vitamin B12, and folic acid and high homocysteine level with recurrent aphthous stomatitis

2014 ◽  
Vol 44 (4) ◽  
pp. 300-305 ◽  
Author(s):  
Andy Sun ◽  
Hsin-Ming Chen ◽  
Shih-Jung Cheng ◽  
Yi-Ping Wang ◽  
Julia Yu-Fong Chang ◽  
...  
Keyword(s):  
Folic Acid ◽  
Vitamin B12 ◽  
Homocysteine Level ◽  
Recurrent Aphthous Stomatitis ◽  
Aphthous Stomatitis

scholarly journals Combined congenital deficiencies of intrinsic factor and R binder

Blood ◽  
1988 ◽  
Vol 72 (3) ◽  
pp. 940-943 ◽  
Author(s):  
J Zittoun ◽  
J Leger ◽  
J Marquet ◽  
R Carmel
Keyword(s):  
Spinal Cord ◽  
Folic Acid ◽  
Vitamin B12 ◽  
Polymorphonuclear Leukocytes ◽  
Megaloblastic Anemia ◽  
Intrinsic Factor ◽  
Serum Vitamin ◽  
Unique Case ◽  
Subacute Combined Degeneration ◽  
Low Serum

Coexisting deficiencies of both intrinsic factor (IF) and R binder were identified in an Algerian boy who presented with severe megaloblastic anemia, growth retardation, and neurologic dysfunction with typical features of subacute combined degeneration of the spinal cord. The anemia responded completely to cyanocobalamin and folic acid. IF was absent from gastric juice, but acid secretion and gastric mucosa were normal. R binders were absent from gastric juices as well as from serum, saliva, and polymorphonuclear leukocytes. The patient's father exhibited absence of R binder in his serum with a low serum vitamin B12 level and was asymptomatic. This unique case of simultaneous IF and R binder deficiencies suggests a genetic association between these two functionally and immunologically dissimilar, but structurally close vitamin B12-binding proteins.

scholarly journals Acquired Thrombotic Thrombocytopenic Purpura in a Patient with Pernicious Anemia

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ramesh Kumar Pandey ◽  
Sumit Dahal ◽  
Kamal Fadlalla El Jack Fadlalla ◽  
Shambhu Bhagat ◽  
Bikash Bhattarai
Keyword(s):  
Vitamin B12 ◽  
Pernicious Anemia ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Hematological Parameters ◽  
Macrocytic Anemia ◽  
Intrinsic Factor ◽  
Serum Vitamin ◽  
Severe Thrombocytopenia ◽  
Thrombocytopenic Purpura ◽  
Intrinsic Factor Antibody

Introduction. Acquired thrombotic thrombocytopenic purpura (TTP) has been associated with different autoimmune disorders. However, its association with pernicious anemia is rarely reported.Case Report. A 46-year-old male presented with blood in sputum and urine for one day. The vitals were stable. The physical examination was significant for icterus. Lab tests’ results revealed leukocytosis, macrocytic anemia, severe thrombocytopenia, renal dysfunction, and unconjugated hyperbilirubinemia. He had an elevated LDH, low haptoglobin levels with many schistocytes, nucleated RBCs, and reticulocytes on peripheral smear. Low ADAMTS13 activity (<10%) with elevated ADAMTS13 antibody clinched the diagnosis of severe acquired TTP, and plasmapheresis was started. There was an initial improvement in his hematological markers, which were however not sustained on discontinuation of plasmapheresis. For his refractory TTP, he was resumed on daily plasmapheresis and Rituximab was started. Furthermore, the initial serum Vitamin B12 and reticulocyte index were low in the presence of anti-intrinsic factor antibody. So with the concomitant diagnosis of pernicious anemia, Vitamin B12 was supplemented. The rest of the immunological workups were negative. Subsequently, his symptoms resolved and his hematological parameters improved.Discussion. While pernicious anemia can masquerade as TTP, an actual association between the two can also occur and needs further evaluation and characterization.

scholarly journals A Case of Juvenile Pernicious Anemia: Study of the Effects of Folic Acid and Vitamin B12

Blood ◽  
1961 ◽  
Vol 17 (5) ◽  
pp. 618-631 ◽  
Author(s):  
DAVID H. CLEMENT ◽  
CHARLES A. NICHOL ◽  
ARNOLD D. WELCH
Keyword(s):  
Folic Acid ◽  
Vitamin B12 ◽  
Pernicious Anemia ◽  
Gastric Juice ◽  
Intrinsic Factor ◽  
Later Life ◽  
Free Hydrochloric Acid ◽  
Specific Therapy ◽  
Sequence Of Events ◽  
Almost All

Abstract Observations on a 4-year-old boy with Addisonian pernicious anemia have been presented. Noteworthy clinical features included the onset of glossitis at the age of 4 months, followed by anemia severe enough to require hospitalization at the age of 1 year. Relapse occurred in the absence of specific therapy with vitamin B12 and was completely unaffected by the administration of folic acid. Studies with radioactive vitamin B12 demonstrated that almost all of the compound administered by mouth was unabsorbed and was recovered in the stools. When the vitamin was given simultaneously with a concentrate of intrinsic factor, however, approximately 70 per cent was absorbed. Furthermore, the child’s gastric juice, when mixed with radioactive vitamin B12 and fed to an adult with pernicious anemia in relapse, failed to enhance the latter’s absorption of the vitamin. The failure of our patient to absorb the vitamin alone, but his ability to do so when it was administered with intrinsic factor concentrate, was also confirmed by the "Schilling test," in which a proportion of the absorbed radioactive vitamin was "flushed" into the urine by parenteral injection of one milligram of conventional vitamin B12. Of special interest was the occurrence in the urine of an unidentified derivative of tetrahydrofolic acid, derived from orally administered pteroylglutamic acid. The presence of this compound in the urine was demonstrated chromatographically when the patient was critically ill with his disease prior to treatment with vitamin B12. Subsequent to therapy with vitamin B12, while the administration of folic acid was continued, the abnormal metabolite of folic acid could not be found in the urine. Similarly, the administration of folic acid did not lead to the appearance of this metabolite in the urine at a time when, after more than two years without specific therapy, a hematological relapse occurred that was much less severe than that previously observed. The implications of these observations, with respect to the metabolic interrelationships of folic acid and vitamin B12, are discussed. Of further interest were the findings of strongly acid gastric juice containing much mucus and free hydrochloric acid. A fairly normal gastric mucosa was demonstrated by biopsy. The meaning of these unusual findings is discussed and an hypothesis to account for them is offered. The probable sequence of events in these patients from childhood to the development of anemia, usually in later life, is set forth.

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