When Pernicious Anaemia Goes Undercover as BPH

As a house surgeon, I was on duty in the hospital when I came across an elderly male patient of age 59, who was experiencing difficulty in urinating. Upon further examination, he exhibited symptoms similar to those associated with urinary obstruction. After conducting several tests including ultrasound, urethrogram, and other routine examinations, all of which came back normal, we concluded that the most likely cause was prostatic hyperplasia. We prescribed Tamsulosin and sent him home.

However, a few days later, the patient returned to the hospital complaining of dizziness and difficulty standing. Upon reevaluation, we discovered that he had developed antibodies against vitamin B12 in his stomach, leading to pernicious anemia. This condition had caused a neurogenic bladder, which was responsible for his urinary symptoms.As I reviewed the patient’s medical history, I learned that he had been experiencing fatigue, and a lack of appetite. However, these symptoms had not been linked to his urinary issues.

Pernicious anemia is an autoimmune disorder that occurs when the immune system attacks and destroys the cells responsible for producing intrinsic factor, a protein necessary for vitamin B12 absorption in the intestines. In this case, the patient’s antibodies had destroyed the intrinsic factor, leading to a vitamin B12 deficiency and ultimately pernicious anemia.

The neurogenic bladder is an uncommon complication of pernicious anemia. Vitamin B12 is essential for the proper functioning of the nervous system. A deficiency of vitamin B12 can damage the nerves responsible for controlling the bladder, leading to a neurogenic bladder.

Upon diagnosis of the patient’s condition, we immediately started him on vitamin B12 injections, which helped to alleviate his symptoms. Over time, his urinary symptoms eventually improved.

This case taught me the importance of conducting thorough evaluations and not jumping to conclusions based on age or common conditions. It also emphasized the need to consider all possible causes of a patient’s symptoms and to conduct proper investigations to ensure a correct diagnosis. Finally, it showed me the importance of linking symptoms that may seem unrelated to uncover underlying conditions that may not be immediately apparent.

About Sahithya Amerneni: A medical student in internship, who is on the cusp of a rewarding and challenging journey in the process of USMLE.


  1. Neurogenic bladder revealing a pernicious anemia :one case report and literature review. By Omar Riyadh N/A
  2. Rare association between pernicious anemia and neurogenic bladder- a case report and literature review LUCAS P.M. APOLÔNIO,1 GERALDO B SILVA JUNIOR,1 AMANDA M.M. DANTAS,1 PASTORA. DUARTE,1 SÔNIA L. SILVA,2 ELIZABETH F. DAHER1
  3. Subacute Combined Degeneration of the Spinal Cord  Qudsiya Z, De Jesus O.

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