Abstract
Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms. Dermatological manifestations associated with this deficiency include skin hyper- or hypopigmentation, angular stomatitis and hair changes. We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two months' duration. Other symptoms included numbness of the hands, anorexia, weight loss, dizziness, fatigability and a sore mouth and tongue. There was no evidence of hypocortisolaemia and a literature search revealed a possible B12 deficiency. The patient had low serum B12 levels and megaloblastic anaemia. An intrinsic factor antibody test was negative. A gastric biopsy revealed chronic gastritis. After B12 supplementation, the patient's symptoms resolved. Family physicians should familiarise themselves with atypical presentations of B12 deficiency. Many symptoms of this deficiency are reversible if detected and treated early.
Highlights
Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms
We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two months’ duration
The case reported below describes a 28-year-old Omani man who presented with brownish-black hyperpigmentation on both hands, which proved to be due to a B12 deficiency caused by chronic atrophic gastritis
Summary
Kawther El-Shafie,1 *Nafisa Samir,[1] Ritu Lakhtakia,[2] Robin Davidson,[1] Ahmed Al-Waili,[1] Muna Al-Mamary,[1] Mohammed Al-Shafee[3]. Vitamin B12 deficiency is common among individuals in developing countries.[1] Its prevalence is often underestimated as it is believed to occur only in strict vegetarians and patients with pernicious anaemia.[1] vitamin B12 deficiency should be suspected in all patients with unexplained anaemia or neurological symptoms.[2] Various dermatological manifestations associated with B12 deficiency are skin hyper- or hypopigmentation, angular stomatitis and hair changes.[3] Hyperpigmentation as the primary presenting symptom of B12 deficiency is rarely reported in the literature.[4] The case reported below describes a 28-year-old Omani man who presented with brownish-black hyperpigmentation on both hands, which proved to be due to a B12 deficiency caused by chronic atrophic gastritis
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