A Reversible Cause of Skin Hyperpigmentation and Postural Hypotension

Vitamin B 12 deficiency results in neuropsychiatric, hematologic, gynecologic, cardiovascular, and cutaneous manifestations. It is seen most commonly in the elderly, malabsorption diseases  (>60% of all cases), vegans, and vegetarians. Manifestations of pernicious anemia may be similar to Addison disease and may lead to a misdiagnosis. Herein, we report two cases of vitamin B 12 deficiency in which clinical features shared many similarities with Addison disease. Both patients presented with progressive darkening of hands and postural hypotension that reversed with replenishment of vitamin B 12 . Vitamin B 12 deficiency should be considered in patients presenting with skin lesions especially with other coexisting autoimmune diseases.