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أكل سمك وبعد سنة أصيب بضعف مترقي وتعب


أكل سمك وبعد سنة أصيب بضعف مترقي وتعب


حالة سريرية

الوصف الكامل Background
A 46-year-old man goes on a camping trip and ingests undercooked pike Fish from a nearby lake. Eleven months later, he complains of progressive weakness and fatigue. His CBC reveals a hemoglobin of 9.6 g/dL. What is the likely cause of his anemia?

A. Folate deficiency
B. Iron deficiency
C. Lead poisoning
D. Pyridoxine deficiency
E. Vitamin B12 deficiency

المرجع

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الطبيبة العجيبة's picture
by
السنة الخامسة


I think
E. Vitamin B12 deficiency
Diphyllobothrium latum causes anemia wtih vitamin B12 deficiency

drferas's picture
drferas
السنة السادسة


that's what I though when I read FISH and the time is 12MONTHS

Diphyllobothrium Latum, maybe we can check by ordering a stool sample and white cell count to see whether Eosinophils are elevated Rolling Eyes

Bellatrix's picture
Bellatrix
بعد التخرج

E. Vitamin B12 deficiency ??
Quote:
maybe we can check by ordering a stool sample and white cell count to see whether Eosinophils are elevated

I think so .. Rolling Eyes

H2O's picture
H2O
السنة السادسة

MCV is a cheap test and can exclude 2 to 3 conditions from the DDx.
KMG's picture
KMG
طبيب مقيم


ممتازين
الجواب الصحيح هو فيتامين ب 12

E is the correct answer.

This man probably ingested larvae of Diphyllobothrium latum from raw freshwater fish. This fish tapeworm causes few abdominal symptoms, but can absorb vitamin B12 (choice E) to a great degree, causing a deficiency. This deficiency causes a macrocytic anemia.

Folate deficiency (choice A) can also cause a macrocytic anemia.

Iron deficiency (choice B) and pyridoxine deficiency (choice D) cause a microcytic anemia.

Pyridoxine deficiency can cause anemia. But, there are neurological symptoms secondary to poor nerve conduction, especially in the hands and feet and it would be unlikely to be caused by the events in the vignette

.
الطبيبة العجيبة's picture
الطبيبة العجيبة
السنة الخامسة


المشلكة هون أنو المريض مارح (غالبا) يتذكر أنو كان آكل سمك من سنة ،لذا يعتبر التشخيص التوجيهي هو ارتفاع الحمضات ،والتشخيص المؤكد هو رؤية البيوض بالبراز.

drferas's picture
drferas
السنة السادسة


This is not a really practical way of putting a question. In reality patients will not tell you that "I went camping a year ago and I ate raw fish" this is too much of a clue . The more important practical way of guessing or reaching the diagnosis of infectious diseases (including worms) is demographics: i,e the large incidence of certain infection in a geographic area and linking that to patient symptoms
This worm "It is seen predominantly in northern Europe and Japan" and having a patient from these areas should lead your to the diagnosis

ABIM's picture
ABIM

After checking and diagnosing the ovums in stool and being sure that the patient had Diphyllobothrium latum infection ,we could ask him "Did you travel to Japan or north Europe a year ago?".
If he said "yes" , we would ask him whether he ate raw fish or not .

(Of course I'm taking about a patient who may visit our clinic in Syria)

I think it's too hard to diagnose this kind of diseases in Syria before checking ovums in stool. But in their countries (Japan for example) it could be easier.

drferas's picture
drferas
السنة السادسة

Quote:
pyridoxine deficiency (choice D) cause a microcytic anemia.

Pyridoxine deficiency can cause anemia. But, there are neurological symptoms secondary to poor nerve conduction, especially in the hands and feet

بس ملاحظة : نقص البيريدوكسين ( ب6 ) تؤدي إلى أعراض عصبية وكذلك زيادته

نقص ب6 = فقر دم صغير الكريات + أعراض عصبية( peripheral neuropathy )
نقص ب9 = فقر دم كبير الكريات
نقص ب12 = فقر دم كبير الكريات + أعراض عصبية(subacute combined degeneration )

الطبيبة العجيبة's picture
الطبيبة العجيبة
السنة الخامسة


[b]I new it
its B12

اللؤلؤة's picture
اللؤلؤة
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