iatroX Rounds #40

The clues

1. 1

   A 64 year old woman presents to her GP complaining of progressive fatigue and lightheadedness over several months.

2. 2

   She reports a bothersome pins and needles sensation in her hands and feet, alongside occasional difficulty maintaining her balance in the dark.

3. 3

   Her medical history includes Hashimoto's thyroiditis, and she mentions that her tongue often feels painful or burning when eating.

4. 4

   Examination reveals a subtle yellowing of the skin and conjunctiva, a smooth and beefy red tongue, and reduced vibration sense in the lower limbs.

5. 5

   Initial blood tests show a haemoglobin of 84 g/L with an elevated mean corpuscular volume of 116 fL; the blood film reveals hypersegmented neutrophils.

6. 6

   Further investigation confirms severe cobalamin deficiency and the presence of highly specific antibodies that block the site where the nutrient binds to its transport protein.

for education and entertainment. not medical advice.