Diagnostic dilemma: A woman kept tasting bleach — and doctors found a hidden cause in her blood
The patient: A 36 -year -old woman in Michigan
Symptoms: The woman went to the emergency room after having experienced severe shortness of breath, abdominal pain and fatigue for about a day. It had complex medical history, in particular obesity, sleep apnea and vitamin deficiencies, as well as psychiatric conditions, such as anxiety, depression and post-traumatic stress disorder (SSPT).
Twice before, she had been hospitalized for psychiatric episodes. But recently, she had received treatments – a daily antidepressant and an injection of antipsychotics with prolonged monthly action – which seemed to keep other episodes from a distance.
What happened next: The patient had received oxygen en route to the hospital. Once there, doctors stabilized it with multiple blood transfusions after laboratory tests indicated anemia, in which the body has too few healthy red blood cells to transport oxygen through the body.
Its blood had low levels of hemoglobin and platelets, the parts of the blood which transport oxygen and help to form blood clotsrespectively. His heart has also shown signs of widening on X -rays, indicating that he compensated the inadequate capacity of the oxygen transport capacity of the blood.
Doctors have tested iron and folate level levels in the patient’s blood, as these nutrients are essential for the formation of red blood cells. The results of these tests were normal, but its level of Vitamin B12 – A critical micronutrient for the formation of red blood cells – was dangerously weak. Subsequent tests have revealed that it wore antibodies that interfere with the absorption of B12.
The diagnosis: These results were consistent with pernicious anemiaa condition in which the body Immune system attacks Stomach cells had to absorb vitamin B12. Without enough B12, the body cannot produce healthy red blood cells and prolonged deficiency can cause cognitive and behavioral changes, including mood disorders and, in certain reports, psychosis.
Given the patient’s psychiatric history, emergency doctors consulted a psychiatric team after being stabilized. At that time, she pointed out that she had tasted a powdered household bleach two or three times a day for more than a month, because she was attracted by her acute smell and her grainy texture. She said that she would licked her finger, would dip her point in the powder, put her in her mouth, blur, then spits and rinse, and she denied the swallowed.
Her family was worried, she said, but she was “worried or disturbed by her behavior”. His doctors noted in a report.
The behavior indicated towards PicaA disorder in which people eat or taste non -food substances, such as dirt, ice or starch. In this case, the compulsion seemed to be linked to the patient’s anemia, in that his deficiency in B12 was at the origin of the blood disorder and behavioral changes.
Treatment: The patient Immediate care has focused on stabilizing its vital signs with intensive surveillance in the intensive care unit and transfusions to restore its blood levels and relieve the burden of its heart. Once stable and deemed adapted to the discharge, it has been prescribed vitamin B12 supplements and drugs to reduce gastric acid. She also agreed to undergo an endoscopy in an ambulatory clinic to verify gastritis or inflammation of the stomach mucosa.
Pernicious anemia “requires vitamin B12 supplementation to reverse the deficiency and to alleviate the corresponding psychiatric symptoms,” noted doctors in the report. However, after leaving the hospital, the patient never returned for follow -up, so doctors do not know if she continued her treatments or if her symptoms have resolved.
Which makes the case unique: In other cases, the PICA has often – but not always – been linked to vitamin and nutrient deficiencies, in particular A lack of iron or zinc. In this case, the behavior came from a serious deficiency in vitamin B12. The clinicians called it “the first of its kind, notable for the underlying anemia of a B12 deficiency”.
The report also noted that the presentation of the patient draws attention to a rare and recently identified variant of PICA called Desiderosmiain which the desires of a person initially seem to be supplied more by the smell than by the taste or the act of ingestion.
The case is a reminder of how psychiatry and medicine should be assessed next to each other to provide holistic care to patients. With her psychiatric history, the patient’s desire for bleach could easily have been rejected as only psychological causes, the authors argued.
The case underlines how such behavioral changes should cause a careful medical assessment in parallel with psychiatric consultation, as they can be the first clue of a hidden and potentially fatal disease, have concluded doctors.
This article is for information only and is not supposed to offer medical advice.
