Pernicious Anemia

A 29 February 2004 article "Diagnosis: Chest Pain, Frequent Cramping, Weakness" in the New York Times Magazine's "Diagnosis" feature describes a 27 year old man seeking medical attention:

"I'm losing my strength," he explained quietly to yet another doctor - Dr. T, a physician in training in her late 20's. "I'm so weak, I'm worried there's something really wrong."

It all started a couple of months ago, when he noticed that his hands and fingers felt numb. Then he started having chest pains - a strange tightness that made it hard for him to breathe.

He was a garbage collector and noticed that the short sprints from house to truck, which had been part of his daily routine, now left him panting. And the cans he emptied felt heavier. His muscles hurt constantly; he had frequent cramps. By the end of the route, his arms and legs shook with fatigue.

There were other symptoms too: he was losing weight -- 20 pounds in two months. And he was tired. After work, he'd nap, get up for supper, then go back to bed. He also had terrible constipation.

One night, just before Christmas, he was shopping with his wife and kept bumping into the shoppers crowding the mall. "I couldn't make myself go straight," he said.

His handwriting, he reported, was like a child's -- barely legible. His fingers could no longer tell the difference between coarse cotton and smooth silk.

The patient had decreased sensation in both his hands and feet -- a so-called stocking-and-glove distribution. When the doctor tapped his joints with her small rubber hammer, there was no spontaneous jerk. No reflexes. When she asked the patient to close his eyes and tell her whether she had moved his great toe up or down, he couldn't say.

Click here to see the result in SimulConsult Diagnostic Decision Support with all the findings combined together. 

The diagnosis of pernicious anemia comes out as the #1 diagnosis based on the findings hyperlinked above.  Adding anemia and low vitamin B12 levels, makes the diagnosis of pernicious anemia even more likely, as shown here.  He was treated with vitamin B12 injections and was improving when the article was written.

Registration is required to click into the software because access to the software is restricted for legal reasons to medical professionals and students.

If you know of interesting cases in the news, in journals or on open Web sites of hospitals or foundations, please contact us and include enough information for us to find the material. The differential diagnosis will change over time as people mull over the case and submit new information to the database about findings in the relevant diseases.