Abstract
A 73 years-old-male patient had been fairly well until six months prior to the admission, when he complained of anorexia and palpitation. He had had rib caries, hepatitis, gallstone over 10 years ago.
Physical examination on admission revealed sligfit generalized pittig edema, anemia and jaundice. His tongue was atrophic. The heart was enlarged towards the both sides.
A systolic murmur was audible at the apex. EKG showed low voltage, prolonged QRS and depressed T wave. The liver and spleen were not palpable.
Hematological examination disclosed hyperchromic anemia and 13 erythroblast per 200 leucocytes. Over half of nucleous cells in bone marrow smears were typical megaloblast. Schiling test was 1.04%.
After admission he was treated with high dosage of V. B12 (1000 mcg/day), cardiac stimulants and antibiotics. On the 5 th day of admission reticulocytes increased to 68‰ and on the 6 th day, however, he suddenly developed dyspnoea and died.
The autopsy revealed fatty degeneration of heart, central necrosis of hepatic lobule, fatty degeneration of tubular epithel of kidney, atrophy of gastric mucosa and marked proliferation of erythroblast in bone marrow.
