Breathless Shadows of Silent Anemia: Unveiling the Hidden Challenge of Combined Iron and Vitamin B12 Deficiency: A Case Report

This case report presents a 44-year-old male army personnel and animal trainer who developed gradually progressive exertional breathlessness over three months, without other cardiorespiratory complaints, prompting differential consideration of occupational and respiratory etiologies owing to his professional environment and exposure to animals. Clinical assessment revealed marked pallor, and the patient’s laboratory investigations established a diagnosis of combined iron and vitamin B12 deficiency anemia, attributable to his recent switch to a vegetarian diet for six months. Hematological evaluation showed a microcytic hypochromic blood picture with low mean corpuscular volume and significantly reduced serum iron and vitamin B12 levels. No evidence was found for infectious, cardiopulmonary, or systemic disease, and classical causes of anemia were excluded through comprehensive testing. Management involved intravenous and oral supplementation of both iron and vitamin B12, leading to rapid resolution of breathlessness and normalization of hemoglobin values and other hematological indices within one week. This case highlights the necessity of thorough dietary history and micronutrient evaluation in adults with unexplained dyspnea, particularly in cases with recent dietary change, as dual deficiencies may obscure classical laboratory features of anemia and delay diagnosis. Early recognition and simultaneous correction of both nutrient deficits are critical in ensuring prompt recovery, preventing complications, and reinforcing the need for systematic diagnostic strategies in similar clinical presentations.