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Case report
Hypotension: an unusual presentation of vitamin B12 deficiency, with complete recovery following cyanocobalamin therapy
  1. Zohaib Yousaf1,
  2. Almurtada Razok1,
  3. Abdel-Naser Elzouki1,2 and
  4. Taher Sabobeh3
  1. 1Internal Medicine, Hamad Medical Corporation Department of Medical Education, Doha, Qatar
  2. 2Clerkship Department, Qatar University College of Medicine, Doha, Ad Dawhah, Qatar
  3. 3Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
  1. Correspondence to Dr Zohaib Yousaf; zohaib.yousaf{at}


Vitamin B12 deficiency and its sequelae are well described and reported, especially in vegetarians. However, its association with haemodynamic instability is not well identified. We report a case of a young man, previously healthy, presenting with fever, hypotension requiring vasopressors and pancytopenia. Extensive workup was unrevealing for possible infective, inflammatory or endocrine causes except for vitamin B12 deficiency. Fever and haematological parameters stabilised after adequate supplementation of cyanocobalamin (vitamin B12).

  • haematology (drugs and medicines)
  • diet
  • vitamins and supplements
  • pernicious anemia
  • medical management

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  • Contributors ZY was involved in planning, writing the manuscript, literature review and patient follow-up. AR contributed towards the reporting of the case, manuscript writing and literature review. A-NE was involved in planning and manuscript review. TS was involved in literature review and writing the discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.