Vitamin B12 deficiency presenting with acute psychosis (P3.9-051)

Objective: To describe a case of vitamin B12 deficiency with acute psychosis in a 27-year-old patient with sub-acute combined degeneration of the cord (SACD) Background: Though an uncommon complication, acute psychosis in vitamin B12 deficiency has been reported and was initially coined as “megaloblastic madness”. Presenting symptoms include fatigue, apathy, irritability, cognitive slowing, and forgetfulness. It can occur with or without other features of vitamin B12 deficiency such as SACD Design/Methods: Case report Results: A 27-year-old HIV-negative man presented to a neurology clinic in Zambia with progressive difficulty walking over one month. Six months prior, he developed an anal fissure with hematochezia and severe anemia (hemoglobin 4) requiring surgical correction to stop bleeding. A month before presentation, he became increasingly withdrawn and was diagnosed with depression in a psychiatric clinic. On presentation, he had a 5 day history of visual and auditory hallucinations, progressive paranoia and had stopped walking. Examination revealed a thin patient responding to auditory and verbal hallucinations who accused the examiner of trying to harm him. He also had a spastic tetraparesis, hyperreflexia with clonus, a palpable bladder, and was unable to walk. He had anemia (Hb – 10, MCV – 106) and vitamin B12 Conclusions: While subacute combined degeneration of the cord and megaloblastic anemia are a common presentation of vitamin B12 deficiency, physicians should be aware of acute pyschosis as a rare, but reversible complication Disclosure: Dr. Zimba has nothing to disclose. Dr. Saylor has nothing to disclose.