Case Report PerniciousAnemiaandVitiligoinanHIVPatient:AnUnfamiliar Case Presentation Katongo Mutengo, 1 Francis Mupeta, 2 andOwenNgalamika 3 1 Department of Internal Medicine, Livingstone Central Hospital, Ministry of Health, Livingstone, Zambia 2 Infectious Diseases Unit, Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia 3 DermatologyandVenereologySection,UniversityTeachingHospital,UniversityofZambia,SchoolofMedicine,Lusaka,Zambia CorrespondenceshouldbeaddressedtoOwenNgalamika;owen_ngalamika@yahoo.com Received 17 March 2020; Revised 15 May 2020; Accepted 16 May 2020; Published 30 May 2020 AcademicEditor:HirotadaAkiho Copyright©2020KatongoMutengoetal.isisanopenaccessarticledistributedundertheCreativeCommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited. Perniciousanemia(PA)isararelyconsideredcauseofanemiainHIV-infectedpopulationandisseldomonthelistofdifferential diagnoses.However,PAcanhaveseriousconsequencesifmisdiagnosedorleftuntreated.Wepresentthecaseofa38-year-old HIV-positivemanwhowasdiagnosedwithPA,whichwasprecededbyaone-yearhistoryofvitiligo.Ourcaseisareminderfor clinicianstohaveahighindexofsuspicionforanautoimmuneprocessasapotentialcauseofanemiainHIV-infectedindividuals. 1.Introduction Anemia is one of the commonest presentations among human immunodeficiency virus- (HIV-) infected individ- uals.However,duetothediversityofetiologicalfactorsin theHIV-infectedpopulationsuchaspoordiet,medications, secondary infections, or the virus itself, anemia is rarely attributed to an autoimmune process [1]. More so, in re- source-limited settings, the high cost of workup coupled withalowindexofsuspicionmakesitalmostimpossibleto investigate for autoimmune causes of anemia such as PA. Yet, if left untreated, PA can have seriously debilitating effects including irreversible neurologic damage and sus- ceptibilitytogastrictumorsassociatedwiththedisease[2]. Scientific evidence shows that autoimmune activation canbetriggeredbyenvironmentalandinfectiousagents[3], includingHIV.But,thedeclineinimmunityassociatedwith HIV would often make the autoimmune process occult whiletheconverseholdstrueaswell[4].DespitePAgen- erallycontributingcloseto90%ofvitaminB12deficiencyin Africa[5],itisrarelyinvestigatedforasacauseofvitamin B12deficiencyintheHIVpopulation,whichmaypresentas a macrocytic anemia. In fact, extensive literature research yields scanty information on PA occurring in HIV population to date. e antipathy of PA and HIV disease processes, therefore, presents a diagnostic enigma to clini- ciansespeciallywhentheautoimmuneprocessiscoexisting inthesettingofalowimmunestatus.Here,wepresentthe case of an HIV-positive Zambian man of African descent diagnosedwithPA,whopresentedwithvitiligoayearbefore thediagnosisofmacrocyticanemia.iscasehighlightsthe needofscreeningforanautoimmuneprocessasacauseof anemiaeveninthepresenceofanunderlyingdiseasewith contrasting pathogenesis such as HIV. 2.CasePresentation A38-year-oldZambianmanofAfricandescentpresentedto Livingstone Central Hospital, a tertiary institution in the southernprovinceofZambia,withahistoryofspontaneous loss of skin pigmentation on the face for 20 months and progressive lethargy for 8 months. e skin hypo- pigmentationstartedassmallpinkpatchesonhischeeksand nosebutprogressivelyincreasedinsize.Hewassaidtobein good health, was energetic, and was able to carry out his usual activities despite the facial hypopigmentation. How- ever,about12monthsaftertheonsetofthiscondition,he describedfeelingweakandtiredonminimalexertionsuchas Hindawi Case Reports in Gastrointestinal Medicine Volume 2020, Article ID 7942453, 5 pages https://doi.org/10.1155/2020/7942453