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case_images: (A) An image of a 65-year-old Chinese woman with glossitis (smooth and red tongue dorsum without lingual papillae) caused by pernicious anemia. (B) Her tongue appears normal three month after starting treatment with methylcobalamin.
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case_images: She had a smooth, red tongue without lingual papillae, suggestive of glossitis (Figure 1A). Three months after discharge, at a follow-up visit, her tongue regained its normal appearance (Figure 1B), and her vitamin B12 level were normal.
case_images: Peripheral blood smear examination showed poikilocytosis: with target erythrocytes, teardrop-shaped red blood cells and oval-shaped red blood cells. Green arrow indicate oval-shaped red blood cell; red arrow indicate teardrop-shaped red blood cell; black arrow indicate target erythrocyte.
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case_images: Target erythrocytes, teardrop-shaped red blood cells and oval-shaped red blood cells could be seen (Figure 2).
case_images: (A and B) Smears of bone marrow aspirates demonstrating megaloblastic changes: nuclear-cytoplasmic dyssynchrony and nuclear irregularity in erythroid lineage cells, and also nuclear-cytoplasmic dyssynchrony, hypersegmentation, and giant metamyelocytes.
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case_images: Bone marrow aspiration was compatible with hyperplastic anemia, and morphologic signs of megaloblastic anemia (Figure 3).
case_images: Endoscopic images of the stomach. (A-C) The typical endoscopic features of atrophic gastritis are apparent, including loss of rugal folds and pallorous-appearing gastric mucosa; due to the thinned gastric mucosa, there is the increased prominence of submucosal blood vessels in the gastric body. (D) There is no atrophy of the mucosa of the gastric antrum.
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case_images: A gastroscopy revealed showed chronic atrophic gastritis (Figure 4).