Abstract

We continue to present Clinical Scenarios for Medical Students. Another clinical scenario is presented by associate professor Sur Genel and his team: a 62 years old female patient who presented to the family doctor for asthenia, memory disorders, paresthesia and joint pain. She was diagnosed with rheumatoid arthritis, vitiligo and pernicious anemia

1. Introduction

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation ¹. Vitiligo is an autoimmune disease that causes the destruction of melanocytes, which are responsible for skin pigmentation. Other autoimmunities are frequently associated with it ². Pernicious anemia (PA) is also an autoimmune disease that affects the gastric mucosa and prevents the absorption of vitamin B12 ^{3, 4}.

2. Case Presentation

We report a case of a 62-year-old female patient who was known by the family doctor to have RA, which was diagnosed at the age of 30, in treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine, methotrexate, and vitiligo, which was diagnosed at the age of 50, after she discovered depigmented spots on her eyelids and face, which then spread to her arms and especially her hands.

At the age of 62, she presented to the family doctor with asthenia, adynamia, joint pain when mobilizing, and difficulty walking. She was hospitalized and underwent investigations that supported the diagnosis of PA. Treatment with injectable vitamin B12 was instituted. The evolution of anemia was favorable.

Paraclinical examinations performed in the medical service showed the presence of megaloblastic anemia with Hb = 6.3 g/dL, erythrocyte sedimentation rate at high values and iron serum levels of 110 mcg/dL. Anti-intrinsic factor antibodies were also present, so the diagnosis was confirmed. Also, the diagnosis of RA (with a positive RF) as well as that of Vitiligo was maintained.

3. Conclusion

What is the main take home message from the present case report?

Funding

Not applicable.

Acknowledgments

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

All authors of this paper have read and approved the final version submitted.

References