Subacute combined degeneration with vitamin B12 deficiency in a patient with bulimia nervosa

Abstract

Context: Subacute combined degeneration (SCD) is a rare cause of myelopathy and is classically due to vitamin B12 deficiency. The typical pathological changes associated with SCD include axonal loss selectively involving the dorsal columns as well as the anterolateral pyramidal pathways. Findings:We report a 22-year old Chinese woman who initially presented with progressive numbness and recurrent falls. Patient was subsequently diagnosed with subacute combined degeneration involving the thoracic and cervical cord based on imaging findings and low vitamin B12 levels. With careful and empathetic interviewing the patient admitted to intermittent self-induced vomiting after periods of compulsive eating consistent with a diagnosis of Bulimia Nervosa. Conclusion:To our knowledge, this is the first case report of subacute combined degeneration due to B12 deficiency secondary to bulimia nervosa.