Pernicious anemia has been associated with various psychiatric manifestations, such as depression, mania and psychosis. Psychiatric symptoms can sometimes occur without hematological and neurological abnormalities and can be prodromal of vitamin B12 deficiency. We report a case of autoimmune B12 deficiency presenting as catatonia without signs of anemia or macrocytosis, in which a correlation was found between the patient's B12 blood levels and catatonic symptoms over time. This catatonic episode was successfully treated with only lorazepam and adequate doses of cyanocobalamin.We report the case of an immunocompetent man who presented with fever and abdominal pain and was found to have a hepatic abscess and a peri-renal abscess with a computerized tomography scan. The hepatic abscess was drained percutaneously and cultures revealed the presence of Lactococcus lactis that was sensitive to penicillin.

The patient was successfully treated with ceftriaxone and metronidazole with resolution of the abscesses. Further work-up revealed atrophic gastritis, vitamin B12 deficiency, periodontitis and gingivitis, suggesting a possible site of entry for the development of the abscesses.Lactococcus lactis is a facultative anaerobic, catalase-negative, gram-positive coccus widely used for the industrial production of fermented dairy products such as milk, cheese and yogurt. Although Lactococcus lactis was considered to be non-pathogenic, it has been reported to cause human disease in the last two decades, in both immunocompetent and immunocompromised patients. Pernicious anemia is a manifestation of autoimmune gastritis resulting from the destruction of gastric parietal cells and the associated lack of intrinsic factor to bind ingested vitamin B12. Malnutrition and micronutrient deficiencies, diabetes and poor oral hygiene are risk factors of periodontal diseases such as gingivitis and periodontitis.

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Journal of  Autoimmune Disorders