{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T14:10:10Z","timestamp":1755785410165,"version":"3.44.0"},"reference-count":11,"publisher":"SMC Media","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Vitamin B12 deficiency is a common finding in medical practice. It is easily treated with supplementation and typically has a favourable prognosis. In rare circumstances, it can hide a severe disease that should be promptly addressed. We report the case of an acute myeloid leukaemia presenting as an initially predictable B12 deficiency in a vegetarian patient with chronic gastritis. The supplementation rapidly corrected the deficit and the accompanying cytopenias. However, in the following month the cell counts fell once again, leading to the suspicion that other aetiology could be lying beneath the surface. Maintaining a normal peripheral blood smear, the bone marrow biopsy showed myeloblasts and extensive fibrosis compatible with the diagnosis of acute myeloid leukaemia. The neoplasm justified the vitamin deficit by excessive cellular turnover, a vicious cycle only uncovered after supplementation and that ultimately led to the patient\u2019s death.<\/jats:p>","DOI":"10.12890\/2022_003635","type":"journal-article","created":{"date-parts":[[2022,11,7]],"date-time":"2022-11-07T04:35:48Z","timestamp":1667795748000},"source":"Crossref","is-referenced-by-count":1,"title":["Acute Myeloid Leukaemia Presenting as B12 Vitamin Deficiency When Multiple Horses Become a Zebra"],"prefix":"10.12890","volume":"9","author":[{"given":"Diana","family":"Ferrao","sequence":"first","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Almeida","sequence":"first","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2022,11,7]]},"reference":[{"key":"10.12890\/2022_003635_ref1","doi-asserted-by":"crossref","unstructured":"<li>Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013;368:149\u201360.","DOI":"10.1056\/NEJMcp1113996"},{"key":"10.12890\/2022_003635_ref2","doi-asserted-by":"crossref","unstructured":"Infante M, Leoni M, Caprio M, Fabbri A. Long-term metformin therapy and vitamin B12 deficiency: an association to bear in mind. <em>World J Diabetes<\/em> 2021;<strong>2<\/strong>:916\u2013931. <\/li>","DOI":"10.4239\/wjd.v12.i7.916"},{"key":"10.12890\/2022_003635_ref3","doi-asserted-by":"crossref","unstructured":"<li>Lacombe V, Lenaers G, Urbanski G. Diagnostic and therapeutic perspectives associated to cobalamin-dependent metabolism and transcobalamins' synthesis in solid cancers. <em>Nutrients<\/em> 2022;<strong>14<\/strong>:2058. <\/li>","DOI":"10.3390\/nu14102058"},{"key":"10.12890\/2022_003635_ref4","doi-asserted-by":"crossref","unstructured":"<li>Shipton MJ, Thachil J. Vitamin B12 deficiency \u2013 a 21st century perspective. <em>Clin Med (Lond)<\/em> 2015;<strong>15<\/strong>:145\u201350. <\/li>","DOI":"10.7861\/clinmedicine.15-2-145"},{"key":"10.12890\/2022_003635_ref5","doi-asserted-by":"crossref","unstructured":"Bakst RL, Tallman MS, Douer D, Yahalom J. How I treat extramedullary acute myeloid leukemia. <em>Blood<\/em> 2011;<strong>118<\/strong>:3785\u201393. <\/li>","DOI":"10.1182\/blood-2011-04-347229"},{"key":"10.12890\/2022_003635_ref6","doi-asserted-by":"crossref","unstructured":"<li>De Kouchkovsky I, Abdul-Hay M. Acute myeloid leukemia: a comprehensive review and 2016 update. <em>Blood Cancer J<\/em> 2016;<strong>6<\/strong>:441. <\/li>","DOI":"10.1038\/bcj.2016.50"},{"key":"10.12890\/2022_003635_ref7","doi-asserted-by":"crossref","unstructured":"<li>Wanitpongpun C, Utchariyaprasit E, Owattanapanich W, Tantiworawit A, Rattarittamrong E, Niparuck P, et al. Types, clinical features, and survival outcomes of patients with acute myeloid leukemia in Thailand: a 3-year prospective multicenter study from the Thai Acute Leukemia Study Group (TALSG). <em>Clin Lymphoma Myeloma Leuk<\/em> 2021;<strong>21<\/strong>:e635\u2013e643. <\/li>","DOI":"10.1016\/j.clml.2021.03.004"},{"key":"10.12890\/2022_003635_ref8","doi-asserted-by":"crossref","unstructured":"<li>Du AX, Hung T, Surmanowicz P, Gniadecki R. Diagnostic challenge of aleukemic leukemia cutis preceding acute myelogenous leukemia: a case report. <em>SAGE Open Med Case Rep<\/em> 2020;<strong>8<\/strong>2050313X20919638. <\/li>","DOI":"10.1177\/2050313X20919638"},{"key":"10.12890\/2022_003635_ref9","doi-asserted-by":"crossref","unstructured":"<li>Konda M, Godbole A, Pandey S, Sasapu A. Vitamin B12 deficiency mimicking acute leukemia. <em>Proc (Bayl Univ Med Cent)<\/em> 2019;<strong>32<\/strong>:589\u2013592. <\/li>","DOI":"10.1080\/08998280.2019.1641045"},{"key":"10.12890\/2022_003635_ref10","unstructured":"<li>Tsukamoto N, Inose K, Matsushima T, Uchiyama T, Sugita Y, Takeuchi T, et al. Atypical leukemia accompanied by vitamin B12 deficiency. <em>Rinsho Ketsueki<\/em> 1992;<strong>33<\/strong>:461\u20136. <\/li>"},{"key":"10.12890\/2022_003635_ref11","doi-asserted-by":"crossref","unstructured":"<li>Vogelsang GB, Spivak JL. Unusual case of acute leukemia. Coexisting acute leukemia and pernicious anemia. <em>Am J Med<\/em> 1984;<strong>76<\/strong>:1144\u201350. <\/li>","DOI":"10.1016\/0002-9343(84)90872-6"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3635\/3279","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3635\/3280","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3635\/3280","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T13:49:20Z","timestamp":1755784160000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/3635"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,7]]},"references-count":11,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.12890\/2022_003635","relation":{"has-manifestation":[{"id-type":"other","id":"1-92-3635-g3279","asserted-by":"subject"},{"id-type":"other","id":"1-92-3635-g3280","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-92","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2022,11,7]]}}}