Vitamin B12 deficiency is a multifactorial condition, with a wide range of clinical presentations from mild to severe anemia and anemia-related neurological deficits. Hemolysis is a unique cause but has increasingly been recognized lately as a possible B12 deficiency presentation. Our patient presented with hemolytic anemia, for which extensive workup has excluded the common hemolysis etiologies. Therefore, it was attributed to B12 deficiency and improved significantly after treatment. Our case highlights the significance of this unusual presentation and its clinical implementation.
Deficiency of vitamin B12 usually presents with symptoms of anaemia or neurological dysfunction. We report a case of a young lady who was found to be vitamin B12 deficient with massive splenomegaly, haemolytic anaemia, and pancytopenia. She was thoroughly investigated for other causes of similar presentation. Her symptoms and blood count drastically improved after two weeks of therapy with vitamin B12 supplementation. After reviewing the literature on unusual cases of vitamin B12 deficiency, our case is a very interesting read as it serves as a reminder for health care providers to be alert for these manifestations, which can be treated by simply replacing vitamin B12.
Splenic infarction can occur as an infrequent thrombotic manifestation in polycythaemia vera (PV) and is usually catastrophic. We describe the case of a middle-aged woman who was diagnosed with PV 3 months before she presented to the emergency department with acute limb ischaemia. A splenic infarction detected on diagnostic imaging during her hospital stay was treated conservatively with modification of her hydroxyurea dose along with pain management, without the need for surgery.
Direct oral anticoagulants (DOACs) are approved for the treatment and prevention of venous thromboembolism (VTE), with multiple advantages they offer over the older available anticoagulant drugs. Cerebral vein thrombosis (CVT) is an uncommon type of stroke that is usually associated with intracerebral hemorrhage (ICH), for which early anticoagulation is still recommended to prevent thrombus expansion, to facilitate recanalization, and to prevent the development of deep vein thrombosis (DVT) and pulmonary embolism (PE). DOACs’ use for the treatment of CVT is an area of clinical equipoise, and hence it is still not recommended especially in the acute phase. This case report presents a patient who was on a therapeutic dose of rivaroxaban after an episode of CVT. He developed another CVT that was evident on an intracranial CT (CT) venogram. This was considered a therapeutic failure of DOACs, specifically rivaroxaban, in preventing the recurrence of CVT. Such observation might add to the existing yet scarce body of evidence regarding the use of DOACs in the anticoagulation management of CVT.
Pulmonary embolism is a potentially fatal condition that encountered in
practice and mandates prompt identification and management. If left
untreated, a delay in diagnosis can be catastrophic for the patient and
carry a significant risk of death.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.