PERNICIOUS ANAEMIA WITH HASHIMOTO’S THYROIDITIS IN A YOUNG MALE—A RARE AUTOIMMUNE DYAD FROM SOUTHERN INDIA

Abstract

Background: Autoimmune pernicious anaemia (PA) is uncommon in India, where most vitamin-B12 deficiency is nutritional. Co-existence with Hashimoto’s thyroiditis (HT) is even rarer and seldom causes full-blown sub-acute combined degeneration (SCD) in young adults.
Case: A 25-year-old South-Indian man presented with acral hyper-pigmentation, spastic paraparesis, proprioceptive ataxia and distal sensory loss. Laboratory evaluation showed pancytopenia, macrocytosis, serum B12 < 159 pg mL⁻¹ and strongly positive intrinsic-factor and parietal-cell antibodies. Thyroid profile revealed raised TSH (10.54 mU mL⁻¹) and anti-TPO titres (366.9 IU mL⁻¹). MRI spine was normal. He was diagnosed with SCD secondary to PA, coexisting with HT.
Management & Outcome: Intramuscular cyanocobalamin (1 mg daily × 7, weekly × 4, monthly × 6) plus levothyroxine produced marked neurological improvement within two weeks.
 Fewer than a dozen Indian cases of the PA–HT dyad have been published. Early recognition and parenteral B12 therapy are essential to prevent irreversible myelopathy in such patients.