Dados do Trabalho

Title

PERNICIOUS ANEMIA: A RARE CAUSE OF ANEMIA IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Anemia is the most common hematologic abnormality in patients with
systemic lupus erythematosus (SLE), affecting more than 50% of patients. Several mechanisms
can contribute to its development, the most common being chronic disease anemia, iron
deficiency anemia and hemolytic anemia.

Case report

A 40-year-old woman with a history of high blood pressure, presented with
fatigue, unintentional weight loss (28kg over 3 months), polyarthralgia, oral ulcers, and Raynaud
phenomenon. Laboratory tests revealed pancytopenia (Hemoglobin: 3,4g/dL, HCT: 11,2%,
MCV: 129, White Blood Cell count: 2900/microL, Platelet count: 49000/microL), positive ANA
(1:320, nuclear speckled pattern), positive anti-SSA, low C3 and C4, and normal reticulocyte
count. A diagnosis of SLE was established and the patient submitted to a three day course of 1g
endovenous methylprednisolone, without improvement of the hematologic parameters. Followup investigation revealed a very low level of vitamin B12, below the limit of detection of the
exam kit. A replacement regimen was initiated, with progressive improvement of cytopenias. An
upper digestive endoscopy was performed, showing atrophic gastritis of the body and gastric
fundus, and the biopsy showed mild gastritis with intestinal metaplasia. Immunologic tests
showe a positive antiparietal cell antibody. After clinical improvement, the patient was
discharged on hydroxychloroquine and vitamin B12 replacement regimen.

Conclusion

: The association of SLE with other autoimmune diseases of the gastrointestinal
tract is described in the literature. Pernicious anemia, characterized by vitamin B12 deficiency
due to the presence of autoantibodies against gastric parietal cells or the intrinsic factor, is a
rare cause of anemia in patients with SLE. Elevated VCM should alert the rheumatologist to this
possibility.