De la artritis a la paraparesia: lecciones clínicas de un caso de alcoholismo para el manejo sistémico en Medicina Interna.

Abstract

The following article addresses the case of a 45-year-old male patient with a history of chronic alcoholism, who developed subacute combined degeneration of the spinal cord secondary to vitamin B₁₂ deficiency. The clinical picture included initial manifestations of gouty arthritis, followed by deep vein thrombosis and flaccid paraparesis with sensory disturbances. The diagnosis was established by correlating clinical findings, laboratory tests (mild anemia, hyperuricemia), and excluding other neurological pathologies, such as multiple sclerosis and alcoholic peripheral neuropathy. Treatment with intramuscular vitamin B₁₂, followed by oral supplementation, resulted in significant clinical improvement, both neurological and hematological. This study underlines the importance of suspecting nutritional deficiencies in patients with a history of excessive alcohol consumption, even in the absence of anemia, to prevent irreversible neurological damage. In addition, the role of hyperhomocysteinemia in the pathophysiology of complications such as hyperuricemia and thrombotic risk is highlighted.