A Case of Subacute Combined Degeneration of the Spinal Cord with Bilateral Shoulder Charcot Joint

Subacute combined degeneration (SCD) of the spinal cord is a rare neurological condition associated with vitamin B12 deficiency, often presenting with diverse musculoskeletal and systemic manifestations. This report describes a unique case of bilateral Charcot joints in the shoulders of a 56 - year - old female patient with a 15 - year history of left and right shoulder pain, numbness and pain in the left palm for 7 years, weakness of both upper limbs for 2 years, and bilateral lower limb weakness for the past 6 months. The patient had a dietary history suggestive of vitamin B12 deficiency, including strict vegetarianism for the past 20 years, without regular supplementation. Laboratory tests revealed a significantly low serum vitamin B12 level of 120 pg/mL (normal range: 200 - 900 pg/mL), along with findings of macrocytic anemia (mean corpuscular volume [MCV] of 110 fL), consistent with megaloblastic anemia. The peripheral blood smear showed hypersegmented neutrophils, further supporting the diagnosis of vitamin B12 deficiency. The patient initially presented to the orthopedic outpatient department (OPD) due to her shoulder pain, and X - rays revealed complete resorption of the humeral heads and glenoid fossae, along with joint effusions and loose bodies. An MRI of the shoulders and cervical spine was performed simultaneously to evaluate her musculoskeletal and neurological symptoms. The MRI confirmed extensive joint destruction in both shoulders and revealed characteristic hyperintensities in the bilateral posterior columns of the cervical spinal cord, confirming the diagnosis of SCD. This case emphasizes the rare coexistence of SCD and bilateral Charcot joints in the shoulders, highlighting the importance of advanced imaging techniques in diagnosing and managing such complex presentations. The findings underscore the necessity of early recognition and treatment of vitamin B12 deficiency to prevent severe complications like neuropathy, joint degeneration, and anemia, contributing to the understanding of atypical manifestations of this deficiency.