A 28-year-old man who saw the doctor because of numbness of the feet is found to have a hematocrit of 26%.Except for frequent bouts of gastritis for which he self-medicated with antacids, there is nothing unusual in his medical history.A blood test shows unusually large erythrocytes, and a metabolic screen reveals methylmalonic acid in his urine.This is most likely a case of:

Question

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The co-occurrence of peripheral neuropathy (numb feet) and megaloblastic anemia, and especially the urinary methylmalonic acid, indicate the diagnosis.The patient's gastritis is most likely caused by the autoimmune process that has destroyed his parietal cells.

A 28-Year-Old Man Who Saw the Doctor Because of Numbness