Inaugural neuropsychiatric manifestations of Biermer disease

Abstract

Introduction: Biermer&#39;s disease is an autoimmune disorder responsible for vitamin B12 deficiency, with diverse inaugural clinical manifestations. Objective and Methods: The main aim of our study was to describe the inaugural neuropsychiatric manifestations in our context. The authors conducted a cross-sectional, multicenter, descriptive study over a 4-year period (2020-2024). Results: Forty-nine patients were enrolled. The mean age was 49 years (24-83), with a female predominance and a sex ratio of 0.69. Biermer&#39;s disease was associated with other autoimmune diseases, notably graves&#39; disease and rheumatoid arthritis in 12.2% of cases. Inaugural neuropsychiatric manifestations were observed in 42.9% of cases. Neurological manifestations were dominated by paresthesias (26.5%) and ataxias (10.2%). Psychiatric manifestations included irritability (4%), delusion syndrome (2%), agitation (2%) and delirium (4%). The anemic syndrome was present in 91.8% of cases, but absent in 8.16%. Clinical aspects remained highly polymorphic. The mean vitamin B12 level was 85.4 ng/ml (13-236). Forty patients (84%) had a collapsed level (< 100 ng/ml). The mean time to diagnosis was 8.8 months (1- 48). The overwhelming majority of patients had received parenteral vitamin B12 supplementation (91.8%). The evolution of clinical signs was marked by the disappearance of psychiatric signs in less than 3 months, and a regression of neurological signs between 6 and 12 months. Conclusion: The neuropsychiatric manifestations of Biermer disease are frequent and polymorphous. Inaugural, they are a source of misdiagnosis. Any atypical or late-onset neuropsychiatric symptomatology (From age 35) should be investigated to rule out Biermer disease.