Plummer‒Vinson Syndrome with Ascending Colon Cancer : A Case Report

Iron deficiency anemia is the most common type of anemia in Jap an, and iron deficiency inhibits blood pigment production, resulting in microcytic hypochromic anemia. Glossitis and angular cheilitis occur owing to the atrophy of the oral mucosa and poor regeneration of the mucosal epithelium. When this is accompanied by dysphagia, it is called Plummer‒Vinson syndrome. Regarding the diagnosis of the iron deficiency anemia, peripheral blood tests reveal microcytic hypopigmented anemia (MCV, ≤80 ; MCHC, ≤30), and the hemoglobin level (Hb) decreases. Biochemical tests reveal a decreased serum iron (Fe) level of <60 μg/dL, decreased serum ferritin levels, and increased total iron binding capacity (TIBC) and unsaturated iron-binding capacity (UIBC). We report a case of Plummer‒Vinson syndrome with the considerable improvement of oral symptoms by iron replacement therapy, and ascending colon cancer was found to be the cause of the iron deficiency anemia. 　A 70-year-old woman complained of abnormal taste. Her eyelid co njunctiva was pale, and her oral cavity showed a partial atrophy of the tongue papillae. Blood test results at h er first visit were as follows: MCV, 69; MCHC, 24.6; Fe, 6 μg/dL; Hb, 4.1 g/dL; TIBC, 445 μg/dL; and UIBC, 437 μg/dL. With the Plummer‒Vinson syndrome diagnosis, the iron replacement therapy with sodium ferrous citrate (Feromia®) and ferric pyrophosphate (Incremin®) was started and blood tests were performed over time. Two months after starting the iron replacement therapy, the hyperemia of the palpebral conjunctiva, recovery of the tongue papillae, and imp rovement of oral symptoms were observed. Blood test results are as follows: Fe, 99 μg/dL; Hb, 10 g/dL; TIB C, 329 μg/dL; and UIBC, 230 μg/dL. Incr eased Fe and Hb levels and decreased TIBC and UIBC levels were observed. Thereafter, ascending colon cancer was confirmed based on the results of a detailed examination of the cause of the iron deficiency anemia at the Department of Gastroenterology. 　These results suggest that the appropriate iron replacement the rapy for Plummer‒Vinson syndrome improves oral symptoms and blood test results at an early stage. Moreover, the active examination of the cause of the iron deficiency anemia was suggested to be necessary for refractory cases not showing long-term improvement.