Abstract:
Megaloblastic anemia is not uncommon in India, but data is insufficient regarding its presentation as pyrexia.
There are many case reports on this topic but very few large sample size studies. We did a prospective study to document
such data for patients with megaloblastic anemia secondary to vitamin B12 and folate deficiency presenting as pyrexia of
unknown origin. A study of 34 cases with megaloblastic anemia in adults above 15 years of age during 1 year
(September 2012 to August 2013) presenting as pyrexia was conducted at SDM College of Medical Sciences and
Hospital, Dharwad, Karnataka state, India. There were 34 patients with megaloblastic anemia secondary to vitamin B12
and folate deficiency based on peripheral smear who presented with fever. Fever and dyspnoea were the main presenting
symptoms. 28 patients had fever of 99 – 102 F and 6 had moderate to high grade fever (>102 F). 17 patients had fever
lasting for less than 7 days, 13 had fever from 7 to 20 days and 4 had fever for more than 21 days .Other symptoms were
generalized weakness 25 (73.5%), vomiting 10(29.4%), loose stools 8 (23.5%), and bleeding tendency in 4(11.76%)
patients. The pyrexia subsided following the intramuscular injection of vitamin B12 and oral folic acid administration.
All the other infective, inflammatory, autoimmune, drugs, endocrine and malignant cause of pyrexia were excluded by
appropriate investigations. All patients presenting with pyrexia should be carefully evaluated for possible vitamin B12
and folate deficiency in order to prevent the unnecessary use of antibiotics and investigations. Megaloblastic anemia
(vitamin B12, folate deficiency) is a reversible cause of pyrexia that should be considered in any patient who presents
with pyrexia especially in those with long duration.
