Insidious onset with stomatitis, glossitis, and degeneration of the spinal cord with demyelination is most consistent with which anemia?

Insidious onset with stomatitis, glossitis, and degeneration of the spinal cord with demyelination is most consistent with which anemia?

• A. Aplastic anemia
• B. Pernicious anemia
• C. Folate deficiency anemia
• D. Iron deficiency anemia

Answer: (B)

The scenario describes vitamin B12 deficiency causing subacute combined degeneration of the spinal cord. Pernicious anemia is a common cause, due to autoimmune destruction of gastric parietal cells and loss of intrinsic factor, which is needed for B12 absorption. Without intrinsic factor, B12 cannot be absorbed, leading to megaloblastic anemia and neurodegenerative changes from demyelination of the dorsal columns and lateral corticospinal tracts. The stomatitis and glossitis reflect mucosal cell turnover being impaired by disrupted DNA synthesis from B12 deficiency. Folate deficiency can cause glossitis and macrocytosis, but it does not typically produce the spinal cord demyelination seen here. Iron deficiency lacks these neuro findings and mucosal stomatitis is less characteristic. Thus, pernicious anemia best explains the combination of mucosal changes and spinal cord demyelination. Treatment involves parenteral B12 replacement, usually lifelong.

The scenario describes vitamin B12 deficiency causing subacute combined degeneration of the spinal cord. Pernicious anemia is a common cause, due to autoimmune destruction of gastric parietal cells and loss of intrinsic factor, which is needed for B12 absorption. Without intrinsic factor, B12 cannot be absorbed, leading to megaloblastic anemia and neurodegenerative changes from demyelination of the dorsal columns and lateral corticospinal tracts. The stomatitis and glossitis reflect mucosal cell turnover being impaired by disrupted DNA synthesis from B12 deficiency. Folate deficiency can cause glossitis and macrocytosis, but it does not typically produce the spinal cord demyelination seen here. Iron deficiency lacks these neuro findings and mucosal stomatitis is less characteristic. Thus, pernicious anemia best explains the combination of mucosal changes and spinal cord demyelination. Treatment involves parenteral B12 replacement, usually lifelong.