Open AccessPigmentation in vitamin B12 deficiency masquerading Addison′s pigmentation: A rare presentation
Author(s) -
Ritesh Kumar Agrawala,
S. Sahoo,
A. K. Choudhury,
Binoy Kumar Mohanty,
Anoj Kumar Baliarsinha
Publication year - 2013
Publication title -
indian journal of endocrinology and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.456
H-Index - 28
eISSN - 2230-9500
pISSN - 2230-8210
DOI - 10.4103/2230-8210.119591
Subject(s) - vitamin b12 , medicine , megaloblastic anemia , stratum spinosum , tongue , dermatology , basal (medicine) , anemia , biopsy , pathology , gastroenterology , stratum corneum , insulin
A 35-year-female presented with generalized weakness, weight loss, and progressive pigmentation was worked up for suspicion of Addisons disease. On examination hyper pigmentation was noted on both palmar and dorsal aspect of hands involving knuckles, creases, feet, tongue, oral mucosa and gluteal region. There was no evidence of hypocortisolemia as initially suspected, and literature search revealed a possibility of vitamin B12 deficiency. She had megaloblastic anemia with a low serum vitamin B12, mostly due to poor dietary intake. Her hyper pigmentation resolved with vitamin B12 supplementation. Skin biopsy showed increased pigmentation at stratum spinosum and basal-layer. The mechanism of hyper pigmentation in vitamin B12 deficiency was due to an increase in melanin synthesis.