Biermer's disease in northern Senegal

Summary: Biermer's disease is an autoimmune disease characterized by the presence of gastritis, various auto-antibodies including intrinsic antifactor antibodies and parietal anticellules and accompanied by malabsorption of vitamin B12. Patients and Methods: This was a prospective study between Janvier 2016to August 2017 at the department of internal medicine of the Saint-Louis regional hospital, Senegal. Results: A number of 23patients were retained for the study with a mean age 51.08 years and the sex ratio M/F at 0.53. Average time to diagnosis was 16 weeks with extreme ages ranging from 2 to 48 weeks. The diagnosis was suspected in the presence of Neurologic-anemic syndrome and confirrmed by low vitamin B12 blood levels and the presence of anti intrinsic factor antibodies. In certain patients, vitamin B12 therapeutic test was contributive. The clinical manifestations were dominated by anemia signs (23 cases), palmo-plantar acquired diffuse melanodermia (13 cases), GIT signs including Hunter glossitis (9) and polyneuropathy. The Anemia was macrocytic in 21 (91.30%) of the cases, normocytic in 2 (8.7%) of the cases. The mean hemoglobin level was at 4.79 g/dl. Serum vitamin B12 low in 14 (60.86%) of the patients with a mean value at 50 pg/ml. Anti intrinsic factor antibodies were positive in 4 (17.39%) of the cases. In patients who had gastroscopy, the histology showed features of chronic atrophic gastritis in 65.21% of the cases. The treatment comprised whole blood transfusions and supplementations of vitamin b12 parenterally. In all of our patients, we noted regression completely of the melanodermia, glossitis and normalization of the hemoglobin. Conclusion: In our study Biermer’s disease is revealed by anemia, melanoderma and gastrointestinal signs contrasting with the rarity or absence of neurological and vascular manifestations. Clinical polymorphism justifies thinking more often and trying to eliminate other differential diagnoses.