An unusual association of folic acid deficiency with gastric neuroendocrine tumor type I

The association of gastric neuroendocrine tumour type I with macrocytic anaemia due to vitamin B12 deficiency is commonly encountered. The etiological cause of macrocytic anaemia must always be precisely established for the subsequent treatment guidance. We present the case of a 63-year-old patient admitted for marked physical asthenia, palpitations, abdominal pain, flatulence, paresthesia in the upper and lower limbs and concentration difficulties. Clinical examination revealed pale, dry skin, Hunter's glossitis, and tachycardic heart sounds. Bloodwork showed pancytopenia with macrocytic normochromic anaemia, vitamin B12 within normal limits, but with low folic acid levels. The reticulocyte crisis was documented on day three after initiating folic acid treatment. Exploration by upper digestive endoscopy and colonoscopy described multiple polypoid tumours in the greater curvature of the stomach. The histopathological and immunohistochemical examination lead to the diagnosis of gastric neuroendocrine tumours (NET) type G1. To our knowledge, there are no reports about an association of this type of tumour with folate deficiency-induced anaemia.