A 73-year-old Japanese man with
Hashimoto's disease and
diabetes mellitus received regular medical checkups for
type 2 diabetes care. Blood tests indicated
macrocytic anemia (red blood cell count, 279×104 /μL;
hemoglobin, 12.2 g/dL; hematocrit, 34.0%; mean corpuscular volume, 121.9 fL). The laboratory data demonstrated a normal
folic acid level with a low
vitamin B12 level. An endoscopic examination indicated no signs of gastric or intestinal
bleeding. Positive results for anti-
intrinsic factor antibodies were strongly suggestive of
pernicious anemia. The patient refused
cobalamin injections to treat the
anemia. However, the
oral administration of
mecobalamin for the treatment of
diabetic neuropathy was simultaneously initiated. Subsequently, the
anemia gradually improved. Oral
mecobalamin was presumably effective for
pernicious anemia management.
Anemia is frequently observed in elderly patients, and the incidence of
pernicious anemia increases with age.
Anemia is conventionally treated with
cobalamin injections. Currently, the
oral administration of
mecobalamin is not the typical treatment for
anemia. However, as in our case, a few reports have documented positive results following oral
mecobalamin treatment. Moreover, oral
mecobalamin is a fairly recent, novel, noninvasive mode of treatment, making it ideal for elderly patients, who are generally frail. This case suggests the efficacy of
mecobalamin for the treatment of
pernicious anemia.