Polineuropatía por déficit de vitamina B12 secundaria a gastritis crónica atrófica y giardiasis
Introduction. In chronic atrophic gastritis atrophy of the stomach glands leads to intrinsic factor deficit, with consequent failure to absorb vitamin B12 and gastric achylia, which predisposes to Giardia infection which in itself leads to depletion of vitamin B12. We describe the case of a patient with peripheral and central nervous system pathology due to lack of vitamin B12 secondary to the combined effect of these two disorders. Clinical case. A 54 year old woman consulted us for paraesthesia and weakness of the legs which had been progressive for the previous two years. She presented with tactile hypoaesthesia, hypoparaesthesia, distal hyperreflexia and dysymmetry of the legs, ataxic-spastic gait and a positive Romberg sign.TheinvestigationscarriedoutshowedtheserumvitaminB12leveltobe3pg/ml(N:180-900),hemoglobin13g/dlandMCV 111 fl with MCHC 348/dl; neurophysiological studies: compatible with demyelinating motor polyneuropathy. Schilling test:deficit of absorption of vitamin B12 which was corrected on administration of intrinsic factor; gastroscopy: atrophic gastritis which confirmed the morbid anatomy findings. There was also flora containing Helicobacter and massive Giardia infection.Replacement and antibiotic therapy was followed by complete remission of the clinical picture. Conclusion. We emphasise the excellent clinical response to treatment in spite of the time elapsed since onset of symptoms
Caso clínico Mujer de 54 años que consultó por parestesias y debilidad en extremidades inferiores de curso progresivo desde hacía dos años. Presentaba hipoestesia táctil, hipopalestesia, hiporreflexia distal y dismetría en extremidades inferiores, marcha ataxoespástica y signo de Romberg positivo. Los estudios realizados revelaron unos niveles séricos de vitamina B12 de 3 pg/ml (N: 180-900), hemoglobina 13 g/dl y VCM 111 fl con CHCM 34 g/dl; estudio neurofisiológico: compatible con polineuropatía motora desmielinizante. Test de Schilling: déficit de absorción de vitamina B12 que se corrige con la administración de factor intrínseco; gastroscopia: gastritis atrófica que confirmó el examen anatomopatológico, además de flora de Helicobacter y masiva infestación por Giardias. Siguió tratamiento sustitutivo y antibiótico con remisión completa de la clínica.
Conclusión Destacamos la excelente respuesta clínica con el tratamiento a pesar del tiempo transcurrido desde el inicio de la sintomatología
