Biermer's disease unveiled: Bilateral macular hemorrhage as a rare manifestation-A case report

The patient, a 30-year-old woman, presented with a sudden, painless, and severe decrease in vision in both eyes. The ophthalmological examination revealed a normal anterior segment and intraocular pressure, but a fundus examination showed bilateral macular hemorrhage. In the absence of a known history, a metabolic and hematological biological assessment was conducted. The assessment revealed megaloblastic anemia with a significantly reduced serum vitamin B12 level. Further examination confirmed Biermer's disease as the cause of her anemia. The patient was started on a regimen of monthly vitamin B12 supplementation, which she will continue for life. This case report highlights the importance of recognizing megaloblastic anemia as a potential cause of spontaneous bilateral retinal hemorrhages. Moreover, it underscores the urgency for healthcare practitioners to promptly investigate and determine the root cause of megaloblastic anemia.