A 27-year-old male presented to the Internal Medicine Department referred by his primary care physician for asthenia of three months duration, nonspecific dizziness and intermittent epigastric pain of moderate intensity.
The relevant personal history included allergic rhinoconjunctivitis.
Its usual treatment consists of a single daily dose of epinephrine 10 mg during the period of seasonal allergy.
The physical examination revealed marked weakness of the skin and mucous membranes.
The laboratory tests revealed hemoglobin of 6.5 g/dL (13-18 g/dL), corpuscular average of lactate 125 mgL-100, leucocytes of 6,000 IU/ALT 1,000,500/mL), platelets of 280,000 IU/mL.
Blood smear showed macrocytic tendency, hypersegmentation of neutrophils and some dacrocytes.
The iron study and folic acid levels were normal, with serum vitamin B12 levels of 62 pg/mL (180880 pg/mL and homocysteine of 32 μmol (4-15 μmol/L).
Gastrin levels are clearly elevated 539 pg/mL (normal < 100 pg/mL).
Treatment is initiated with intramuscular injections of 1,000 μg/ day of vitamin B12 for 7 days, weekly thereafter for one month and maintenance therapy with one injection per month.
Blood count returned to normal within the fourth week of treatment.
