Localised skin hyperpigmentation as a presenting symptom of vitamin B12 deficiency complicating chronic atrophic gastritis

Kawther El-Shafie, Nafisa Samir*, Ritu Lakhtakia, Robin Davidson, Ahmed Al-Waili, Muna Al-Mamary, Mohammed Al-Shafee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)e420-e423
JournalSultan Qaboos University Medical Journal
Issue number3
Publication statusPublished - 2015
Externally publishedYes


  • Atrophic gastritis
  • Case report
  • Hyperpigmentation
  • Oman
  • Vitamin B12 deficiency

ASJC Scopus subject areas

  • Medicine(all)


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