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June 19, 1987

Orthostatic Hypotension and Pernicious Anemia

JAMA. 1987;257(23):3231. doi:10.1001/jama.1987.03390230067025

To the Editor.—  Dr Johnson1 described a "second case" of reversible orthostatic hypotension of pernicious anemia in a recent issue of The JOURNAL. While we were cited in his report as the authors of a similar report2 of what was considered to be an index case of this syndrome, I want to give credit where credit is due.The first case of orthostatic hypotension associated with pernicious anemia in which there was recovery following vitamin B12 therapy was published in JAMA by Kalbfleisch and Woods3 in 1962. In this particular case, the patient was quite ill and was hospitalized for almost four months. There was clearly a response to vitamin B12 therapy by the second week of hospitalization. The patient was not rechallenged, but this was a well-documented association between orthostatic hypotension, pernicious anemia, and improvement with replacement vitamin B12 therapy.Fortunately, all three