title: [Megaloblastic anemia in a psychogenic eating disorder].
abstract: METHODS
  A 68-year-old woman had progressively lost strength over the past 5 years and become bed-ridden. She reported gradually reducing her diet during the last few years, for the last two years restricting herself to oatmeal, biscuits and water. Acute exacerbation of dyspnoea, dizziness, tachycardia and cardiac arrhythmias for the last 3 month necessitated her emergency admission when she was found to have oedema of the limbs and definite jaundice, as well as predominantly distal sensory deficits in the legs, a slightly ataxic gait and poor reflexes in the limbs.
  
  
  METHODS
  She was found to have pancytopenia with marked megaloblastic anaemia (haemoglobin 4.8 mg/dl, mean red cell volume 141.8 fl, leukocytopenia 41/nl), marked haemolysis (lactate dehydrogenase 1629 U/l, haptohaemoglobin < 0.1 g/l, total bilirubin concentration 4.5 mg/dl). Pernicious anaemia was excluded: no antibodies against parietal cells and intrinsic factor, and no atrophic gastritis in a gastric biopsy.
  
  
  METHODS
  Megaloblastic anaemia due to dietary deficiencies with early funicular myelosis was suspected. After infusion of four erythrocyte concentrates and vitamin B12 administration the symptoms and blood picture improved within days.
  
  
  CONCLUSIONS
  Although dietary causes of megaloblastic anaemia are rare in Central Europe, they must be considered in the differential diagnosis, especially in the elderly and those with psychogenic disorders.
authors.affiliation: Medizinische Klinik und Poliklinik, Ruprecht-Karls-Universität Heidelberg.
authors.forename: J
authors.initials: J
authors.lastname: Pohl
authors.forename: W
authors.initials: W
authors.lastname: Stremmel
mesh_terms: D000368:Aged; D000749:Anemia, Megaloblastic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D017707:Erythrocyte Transfusion; D001068:Feeding and Eating Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex