Rural health challenges in Western Uganda: pernicious anemia masquerading as recurrent lower limb weakness-a case...

Pernicious anemia, also called Biemer's disease, is an autoimmune disease and the most common cause of cobalamin deficiency globally. Various genetic, environmental, and immunological factors interplay to lead to its presentation. Pernicious anemia has a myriad of presentations, which can range from hematological and skin-related to neurological. Pernicious anemia has been reported among people of all ages worldwide, especially those over 60 years old. Its prevalence in the general population is about 0.1% and 1.9% for elderly patients over 60 years old. Like most other autoimmune diseases, females are more affected than males. However, there are case reports of pernicious anemia occurring in individuals at 40 years of age. The prevalence of pernicious anemia in Africa has been reportedly low, possibly owing to underdiagnosis.

This case identifies a 51-year-old Ugandan man from the tribe of Ankole who presented with lower limb weakness for about 2 months. He had a similar presentation 7 years prior for which he was treated for vitamin B12 deficiency. Initial blood counts revealed macrocytic anemia. Considering the recurrence of symptoms, serum cobalamin levels and serum intrinsic factor autoantibodies were tested and the diagnosis of pernicious anemia was confirmed. The patient improved on parenteral methylcobalamin therapy.

This case report highlights the importance of a high index of suspicion in early diagnosis of vitamin B12 deficiency as a cause of neurological symptoms and in considering the diagnosis and empiric therapy for pernicious anemia in a resource-limited context.