Pernicious anemia can present with which neurologic finding?

• A. Petechiae and ecchymosis
• B. Cheilosis and koilonychia
• C. Splenomegaly and hepatomegaly
• D. Loss of position and vibratory sensation

Answer: (D)

Pernicious anemia causes vitamin B12 deficiency, which can lead to demyelination of the dorsal columns and lateral tracts in the spinal cord. This affects vibration and proprioception, producing loss of position sense and diminished vibratory sensation. That neurologic hallmark—impaired coordination and sensory losses for vibration and position—fits neuro manifestations of B12 deficiency, sometimes even before hematologic signs become prominent.

The other options reflect findings not typical of B12 deficiency: petechiae and ecchymosis suggest platelet issues rather than neural involvement; cheilosis and koilonychia point toward iron deficiency; splenomegaly and hepatomegaly indicate other hematologic or hepatic conditions. The described neurologic change is the best match for pernicious anemia’s neurologic presentation.