Biermer disease disclosed by mucous ulcerations

Pernicious anemia rarely induces mucous membranes lesions, which, exceptionally reveal the disease. We report a case of a 64-year-old man who presented a clinical history of recurrent painful ulcerations of the buccal, genital and occular mucosa. He also had peripheral sensory nerve impairement of the legs. The diagnosis of pernicious anemia was made after a 19 year course. Cobalamin supplementation induced an improvement of the mucous membrane lesions and of the anemia, but recurence occured each time the treatment was stopped. Our observation is particular by the multiple mucous membrane involvement revealing pernicious anemia and by the ocular lesions which had never been previously reported.