Philippine E-Journals

Lumos! Reversing Dementia in an Elderly Female Diagnosed with Megaloblastic Anemia

Boris – Jruing J. de Guzman | Enrico E. Tuy

 

Abstract:

Introduction: We present a case of an elderly female with presenting with dementia caused by Vitamin B12 and folic acid (FA) deficiency which are important causes of reversible dementia. Case: This is a case of an 83-year-old woman who was brought in due to chronic bouts of diarrhea. Review of systems revealed recent onset dementia, progressive weight loss, body malaise and anorexia due to dysgeusia. She appeared weak with hyperpigmented patches over her arms and legs, and a hypopigmented patch over her pudenda. She had pale palpebral conjunctiva with a swollen reddish smooth tongue. Mini-mental status exam revealed a confused, disoriented patient with constricted affect and a recent change in behavior. Complete blood count revealed trilineage pancytopenia with a markedly reduced reticulocyte count and a peripheral blood smear of macroovalocytes and hypersegmented neutrophils. Bone marrow biopsy showed a reactive normocellular bone marrow with trileneage hematopoiesis. She was diagnosed with megaloblastic anemia and given Mecobalamin 500mcg IV once daily for 7 days and folic acid 5mg tablet once daily. One month after discharged, on follow-up, the patient’s neurologic symptoms of confusion, change in behavior and dementia-like presentation were all reversed. The hyperpigmented lesions were markedly reduced. The glossitis diminished and her bowel movement returned to normal. The patient was continued on Mecobalamin 500mcg IV once a month and a daily FA supplementation. Discussion/Conclusion: Vitamin B12 and FA deficiency are important causes of reversible dementia that should be identified immediately due to their life-changing potential.