Severe Anemia From Vitamin B12 Deficiency Presenting With a Craving for Bleach Powder: An Odd Case of Pica

Pica, the ingestion of nonnutritive substances, represents a complex and poorly understood phenomenon. Although it is inherently a psychiatric condition, it has an intricate relationship with other psychiatric, physiological, and pathological states, suggesting a highly multifactorial etiology. Recognizing and addressing pica in acute settings is crucial, as it poses significant health risks for patients, including the potential of toxic ingestion. Our presentation highlights the case of a 36-year-old woman with a complex psychiatric history who presented to the emergency department (ED) with severe symptomatic anemia. Her anemia was found to be macrocytic and a result of autoimmune-induced vitamin B12 deficiency. Further inquiry uncovered that, prior to admission, the patient exhibited a craving for smelling bleach powder that progressed to mouthing the toxic substance for more than a month. This is the first report of a case of bleach craving in a patient with vitamin B12 deficiency absent coexisting iron-deficiency. This unique presentation underscores the importance of psychiatric consultations as a part of comprehensive clinical assessments in emergency medical settings. We also suggest that pica presentations may be nuanced and thus it is critical to understand the biopsychosocial factors driving this behavior and target interventions in the appropriate medical domains.