Think Beyond Sepsis: Megaloblastic Crisis as a Reversible Cause of Pancytopenia and Shock

Megaloblastic anemia is an easily treatable cause of pancytopenia. Most cases have mild hematologic or neurologic symptoms. However, few may come in emergency with megaloblastic crisis characterized by abrupt onset of pancytopenia, hemodynamic instability, and multi-organ involvement. Early recognition of this reversible cause of bone-marrow failure is critical, as prompt administration of hematinics and supportive therapy can result in complete hematologic recovery and favorable outcomes. We report a case of a 19-year-old vegetarian male presenting with severe pancytopenia, shock, and seizures, ultimately diagnosed with megaloblastic crisis after ruling out hemolysis, sepsis and other mimicking conditions. He made a complete hematologic recovery following timely vitamin supplementation and supportive care and had no complaints on follow up after two months, with continuing Vitamin B12 supplementation.