Anemia perniciosa y atrofia gástrica

Varon de 84 anos agricultor, diagnosticado el 2001 de anemia megaloblastica asociada a deficiencia de vitamina B12, polineuropatia sensitivo-motora en miembros inferiores y atrofia gastrica (AG) con metaplasia intestinal. Fue tratado con combinaciones de acido folico 1000 mcg y cianocobalamina 8mcg, mejora y normaliza cifras de hemoglobina tras 2 meses de terapia. Un ano despues, abandona el tratamiento, por sentirse mejor. La anemia y la signologia de polineuropatia sensitivo motora con inadecuada percepcion gustativa de los sabores normales reaparecen el 2008. Por esta epoca los estudios demuestran : pancitopenia, anemia megaloblastica severa, deficiencia de Vit B12, atrofia gastrica, polipos y xantomas en la superficie gastrica, metaplasia intestinal, alteraciones de lipidos sericos, xerosis facial y maculas blancas (2-3 mm) generalizadas. Recibio tratamiento con cianocobalamina parenteral, el paciente persiste (2012) con su AG, aunque la polineuropatia sensitivo-motora desaparecio y sus niveles de hemoglobina son normales. We present the case of an 84-year old male farmer, who was diagnosed in 2001 with megaloblastic anemia associated to vitamin B12 deficiency, sensory-motor polyneuropathy in his lower limbs and gastric atrophy with intestinal metaplasia. The patient was tr eated with a combination including 1000 mcg folic acid and 8 mcg cyanocobalamin. He impr oved his hemoglobin levels back to normal after 2 months of therapy. One year later, he stooped therapy because he was feeling better. In 2008, anemia and the sensorial motor polyneuropathy reappeared, together with an inadequate perception of normal flavor. At this time studies showed the following: pancytopenia, severe megaloblastic anemia, vitamin B12 deficiency, gastric atrophy, gastric polyps and xanthomas, intestinal metaplasia, serum lipid abnormalities, facial xerosis and generalized white spotted macular lesions (2-3 mm). He was treated with parenteral cyanocobalamin, and the patient now still has gastric atr ophy, although the sensorial-motor polyneuropathy had disappeared and his hemoglobin levels are once again normal.