No abstract

The hematological manifestations of cobalamin (vitamin B12) deficiency may range from asymptomatic to life-threatening forms. Pseudothrombotic microangiopathy is a rare but severe presentation, characterized by the presence of hemolysis and schistocytosis, that is completely reversible after vitamin supplementation.We present a challenging diagnostic approach of a 55-year-old man who presented with high hemolytic markers, pancytopenia, and schistocytes on the peripheral smear due to acquired cobalamin deficiency. Subsequent testing revealed positive anti-intrinsic factor and anti-parietal cell antibodies consistent with pernicious anemia. Cobalamin replacement led to the resolution of microangiopathic hemolysis and clinical improvement, thereby confirming the diagnosis. This case highlights the importance of early recognition of this syndrome, which is often misdiagnosed as true microangiopathic hemolytic anemia, confounding appropriate management.

Neurosyphilis refers to the involvement of the central nervous system by Treponema pallidum . Ocular syphilis can present with a range of manifestations, uveitis being the most common, and it can occur at any stage of acquired syphilis. There are multiple tests available for the diagnosis of syphilis. Moreover, the treatment of syphilis depends upon the stage of the disease. For years, the management of syphilitic uveitis was controversial among physicians, with several reviews debating whether ocular syphilis is a subtype of neurosyphilis. Recent recommendations state that ocular syphilis should be treated similarly to neurosyphilis, even with a normal liquor examination. Herein, we describe a case of a 57-year-old male patient who was diagnosed with ocular syphilis.

Macrocytosis is defined as a mean corpuscular volume greater than 100 femtolitres (fL). There are several causes for macrocytic anaemia, and they can be divided into megaloblastic or non-megaloblastic anaemia. Vitamin B12 deficiency is one of the most common causes of megaloblastic anaemia.The cause of vitamin B12 deficiency must be evaluated including the presence of pernicious anaemia as it could alter the treatment and follow-up.Pernicious anaemia can be associated with other autoimmune diseases constituting polyglandular syndromes.

Renal cysts are relatively common, increasing in prevalence with age [1-3]. They are usually benign and asymptomatic, with their diagnosis being incidental on imaging exams. In some cases, however, they can reach large dimensions, leading to symptoms and/or complications [3,4].