A case of subacute combined degeneration of the spinal cord caused by autoimmune gastritis misdiagnosed with repeated failures of <i>Helicobacter pylori</i> eradication

A woman in her 60s had been experiencing numbness in her hands and feet for two weeks prior to the hospitalization, and had difficulty walking. Five years ago, eradication therapy for Helicobacter pylori was attempted twice, but was deemed unsuccessful. Current symptoms: redness of the tongue, stocking-glove type paresthesia, decreased deep sensation in the lower limbs, and trunk ataxia. Blood vitamin B12 levels were low, and a thoracic spinal cord MRI showed symmetric high signals in the posterior columns of the spinal cord. Subacute combined degeneration of the spinal cord was suspected, and vitamin B12 injections were started, allowing the patient to walk independently. Anti-intrinsic factor and anti-gastric parietal cell antibodies were positive, and atrophic gastritis was found on gastroscopy. Based on the above, it was determined that the cause was impaired vitamin B12 absorption due to autoimmune gastritis. In recent years, it has been pointed out that autoimmune gastritis is common among cases of repeated failure of H. pylori eradication, and there is a possibility that this may lead to vitamin B12 deficiency neurological disorders.