Severe neuropsychiatric symptoms due to vitamin b12 deficiency: a case of pernicious anemia or metformin use?

Pernicious anemia is the leading cause of vitamin B12 deficiency and requires an early diagnose and proper treatment since it is a reversible form of acute psychosis and demyelinating nervous system disease 1. Less frequently, metformin therapy, especially on high doses and for long time treatment, can also cause vitamin B12 deficit, but the coexistence of anemia and neuropsychiatric symptoms is rarely seen. We describe a case of a...