Association pernicious anemia and autoimmune thyroiditis: A case-report and review of literature

Pernicious anemia was first described by Thomas Addison in 1849, anemia has been linked to stomach by Austin Flint in 1860 [1]. A woman aged 85 years, was admitted for investigation of anemia discovered incidentally. She was followed for type 2 diabetes, hypertension, dyslipidemia and rectal adenocarcinoma surgery. Clinical examination found a mucocutaneous pallor. The hemoglobin level was 7.3 g/dL, a mean corpuscular volume to 86 microns, platelets 350 000, reticulocyte 83 giga/L, prothrombin time 81%. This assessment of anemia was supplemented by iron status, which turns normal and vitamin status indicating a vitamin B12 deficiency estimated at 108 pg/mL, without vitamin B9 deficiency. We are in the presence of a regenerative normocytic anemia with vitamin B12 deficiency. Positivity of anti-intrinsic factor antibodies and parietal cell antibodies, and an increased gastrin. The diagnosis of pernicious anemia was confirmed by gastroesophageal gastroduodenal endoscopy; on a macroscopic level, an atrophic fundus lesion with hummocky was found, whose biopsies confirmed the appearance of atrophic gastritis with enterochromaffin-like cell hyperplasia. On the metabolic level, we noted the presence of a disturbed thyroid function with increased TSH. Positivity of anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies, which reveal the presence of autoimmune thyroiditis; it is also reinforced by the thyroid ultrasound finding an aspect of autoimmune thyroiditis consistent with Hashimoto’s thyroiditis. The rest of the immunological balance did not find others autoimmune diseases such as Sjogren disease, or autoimmune diabetes. Therefore, we are faced with a patient with the association of pernicious anemia and Hashimoto’s thyroiditis.