Rationale: Although vitamin B 12 deficiency is a well-known complication following total gastrectomy, subacute combined degeneration (SCD) rarely develops beyond 5 years postoperatively. Eight-year latency cases are rarely reported, especially when combined with chronic alcohol use, which accelerates neurologic decline and worsens prognosis. This report aims to present a rare case of delayed SCD after total gastrectomy in a patient with chronic alcoholism, emphasizing the importance of lifelong vitamin B 12 monitoring in high-risk individuals. Patient concerns: A 49-year-old man presented with progressive quadriparesis and sensory disturbances eight years after total gastrectomy for gastric cancer. He also had a significant history of chronic alcohol consumption, raising suspicion for multifactorial vitamin B 12 deficiency. Diagnoses: Laboratory tests revealed severe vitamin B 12 deficiency, pancytopenia, and elevated homocysteine and methylmalonic acid levels. Cervical spine magnetic resonance imaging revealed T2-weighted hyperintensity in the dorsal columns, consistent with SCD. Interventions: The patient received vitamin B 12 supplementation and underwent a comprehensive rehabilitation program aimed at improving motor function. Outcomes: After rehabilitation, he regained independent ambulation using a cane. Lessons: This case shows an unusually prolonged latency of SCD after total gastrectomy and is notable for the coexistence of 2 established risk factors: gastrectomy and chronic alcoholism. It emphasizes the importance of lifelong surveillance of vitamin B 12 status to prevent avoidable and potentially irreversible neurologic complications in high-risk populations.
Cho et al. (Fri,) studied this question.