MEGALOBLASTIC-ANEMIA DUE TO FAULTY NUTRIT ION

History and clinical findings: Over a period of about 6 weeks a 49-yea r-old woman developed increasing exercise-dependent dyspnoea. Her gene ral practitioner had diagnosed marked megaloblastic anaemia and she wa s hospitalised for its further elucidation. She reported to have eaten or drunk nothing but sweets, potato chips, salty pretzels, lemonade, coffee and tea over the last 2 years, Alcohol intake had been reliably denied by her and outsiders. On admission she weighed 106 kg, her hei ght was 167 cm, and she looked anaemic, had dyspnoea and a sinus tachy cardia. There was no evidence of external or internal bleeding and the physical examination was otherwise unremarkable. Investigations: Labo ratory tests showed a haemoglobin concentration of 4.7 g/dl, as well a s marked folic and vitamin B-12 deficiency. The food items taken by he r contain practically no cobalamine and no folic acid. Gastroscopy rev ealed grade 1 reflux oesophagitis. Malabsorption being excluded (norma l Schilling test, no demonstrable autoantibodies against parietal cell s, no evidence of exocrine pancreatic insufficiency), the lack of both vitamins and the megaloblastic anaemia caused by it could be explaine d only by a deficient food intake over several years. Treatment and co urse: After administration of cobalamine (1 mg intramuscularly twice w eekly for 6 weeks, then 300 mu g daily by mouth for 4 weeks) and folic acid (5 mg twice daily for 10 weeks), as well as a well-balanced diet as prescribed by a dietician, reticulocyte and erythrocyte concentrat ions had quickly risen to normal at a follow-up examination 2 months l ater. Conclusion: The case of an anaemia entirely caused by a deficien t diet clearly illustrates the need of a well-balanced food intake eve n in adults.