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VOLUME 10 , ISSUE 2 ( May-August, 2023 ) > List of Articles


Rare Mucocutaneous (Dermatological) Manifestations of Vitamin B12 Deficiency: A Case Series

Anuradha Deuri, Asif Mohammed Oleeur Rahman Mazumder, Arup Kumar Sarma, Nasreen Kausar, Jithin J Chandran

Keywords : Deficiency, Hyperpigmentation, Mucocutaneous, Vitamin B12

Citation Information : Deuri A, Mazumder AM, Sarma AK, Kausar N, Chandran JJ. Rare Mucocutaneous (Dermatological) Manifestations of Vitamin B12 Deficiency: A Case Series. Bengal Physician Journal 2023; 10 (2):59-68.

DOI: 10.5005/jp-journals-10070-8008

License: CC BY-NC 4.0

Published Online: 07-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Vitamin B12 deficiency is widespread in developing countries, especially in Africa, India, South and Central America. It affects 1–2% of the general population and 10–15% of older adults and hospitalized patients. The evaluation includes a detailed history of associated conditions and symptoms; an examination for gastrointestinal, dermatological, neurological, and other findings, and laboratory testing, including complete blood count (CBC) and vitamin B12 and folate levels. The prevalence of vitamin B12 deficiency is higher in vegans. Less commonly mucocutaneous presentations usually Addisonian-like hyperpigmentation over knuckles palms, and soles, diffuse/symmetric or a few scattered macules can occur. The hypothesis regarding pathophysiology behind these includes the decrease in the reduced form of glutathione increasing the activity of tyrosinase; second defective melanin transfer between melanocytes and keratinocytes and finally disturbed melanin distribution due to megaloblastic changes in keratinocytes. Here we present a case series of eleven patients ages varying from 22 years to 71 years, who presented with a history of multiple blood transfusions with rare findings of mucocutaneous hyperpigmentation, very prominent in the hard and soft palate, tongue, buccal mucosa and accentuated hyperpigmentation in upper limb and lower limb, all over face. Few cases also presented with whole-body pigmentation. They all presented high mean corpuscular volume (MCV) (>120) with severe anemia with hypersegmented neutrophils, normal cortisol, and very low serum vitamin B12. All related investigations were done. They have previously tried treatment with oral vitamin B12 supplements, but they didn't respond. Now they were treated with intramuscular vitamin B12 and all patients started to respond with clinical and lab oratorical values. There were also improvements in hyperpigmentation also.

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