Vitamin B12 deficiency can manifest in various forms, including skin changes in the form of hyperpigmentation. The hyperpigmentation in vitamin B12 deficiency commonly presents over the hands and feet, but presenting over the face and oral cavity is very rare. Here we describe an interesting case where there was hyperpigmentation in the face and oral cavity which was mimicking Addison's disease, but the actual diagnosis was vitamin B12 deficiency. This case stresses that knowing the uncommon manifestations of common disease is more important than knowing the common manifestations of uncommon disease.
SinglaRGargASuranaV, et al.Vitamin B12 deficiency is endemic in Indian population: a perspective from north India. Indian J Endocrinol Metab2019; 23: 211–214.
2.
de BenoistB. Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Food Nutr Bull2008; 29: S238–S244.
3.
O'LearyFSammanS. Vitamin B12 in health and disease. Nutrients2010; 2: 299–316.
AaronSKumarSVijayanJ, et al.Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Neurol India2005; 53: 55–58; discussion 59.
6.
BakerSJIgnatiusMJohnsonS, et al.Hyperpigmentation of skin. A sign of vitamin B12 deficiency. Br Med J1963; 1: 1713–1715.
7.
TayemLLitaiemNJonesM, et al.Reversible facial hyperpigmentation associated with vitamin B12 deficiency. Nutr Clin Pract2017; 32: 275–276.
8.
DeuriAMazumderAMORSarmaAK, et al.Rare mucocutaneous (dermatological) manifestations of vitamin B12 deficiency: a case series. Bengal Physician J2023; 10: 59–68.
9.
AgrawalaRKSahooSKChoudhuryAK, et al.Pigmentation in vitamin B12 deficiency masquerading Addison’s pigmentation: a rare presentation. Indian J Endocrinol Metab2013; 17: S254–S256.
10.
SrivastavaNChandSBansalM, et al.Reversible hyperpigmentation as the first manifestation of dietary vitamin B12 deficiency. Indian J Dermatol Venereol Leprol2006; 72: 389–390.
11.
SharathSSinhaS. Mucocutaneous hyperpigmentation as the initial manifestation of vitamin B12 deficiency in an infant. Asian J Pediatr Dermatol2023; 1: 57–59.
12.
VijayVAhmedMSinghY. Reversible hyperpigmentation due to vitamin B12 deficiency – mimicking Addison’s pigmentation. Indian J Postgrad Dermatol2024; 2: 42–44.
13.
HasanSHSamadRDasJC, et al.Hyperpigmentation with vitamin B12 deficiency in an adolescent girl. J Bangladesh Coll Physicians Surg2021; 39: 62–67.
14.
RzepkaZRespondekMRokJ, et al.Vitamin B12 deficiency induces imbalance in melanocytes homeostasis–a cellular basis of hypocobalaminemia pigmentary manifestations. Int J Mol Sci2018; 19: 2845.
15.
MoriKAndoIKukitaA. Generalized hyperpigmentation of the skin due to vitamin B12 deficiency. J Dermatol2001; 28: 282–285.
16.
SantraGPaulRGhoshSK, et al.Generalised hyperpigmentation in vitamin B12 deficiency. J Assoc Physicians India2014; 62: 714–716.
