손발바닥 농포증 및 자가면역성 위축성 위염과 관련된 아급성연합변성

Abstract

We report the case of a 50-year-old woman with vitamin B12 deficiency who presented with severe neurologic deficits associated with bilateral long T2-weighted hyperintensities on spine magnetic resonance imaging (MRI) accompanied by sensory polyneuropathy. The patient was diagnosed with palmoplantar pustulosis six months before admission. She reported progressing numbness and tingling sensation on both hands and legs one month before the hospital visit. Laboratory exams detected decreased vitamin B12 (< 90 pg/mL) and circulating anti-parietal cell antibodies. Endoscopic test showed chronic atrophic gastritis at the third portion of the duodenum. The patient was diagnosed with subacute combined degeneration (SCD). Six months after commencing vitamin B12 treatment, remissions of the symptoms were achieved. In addition, the results of the laboratory, electromyography and cervical MRI tests were improved. Vitamin B12 deficiency must be suspected in people presenting with neurological symptoms with palmoplantar pustulosis.