logically due to incontinentia pigmenti. It is one of the most frequent signs of ... A 14 year old male presented weakness and tiredness from one week. He was a ...
Short case
Eur. J. Pediat. Dermatol. 27, 125, 2017
Hyperpigmentation Caused By Vitamin B12 Deficiency Is Completely Reversible Key words Vitamin B12 deficiency, hyperpigmentation. Vitamin B12 deficiency may be due to congenital or acquired causes that involve reduced enteric gastrointestinal absorption of the vitamin. An exclusively vegetarian diet may be the source of vitamin B12 deficiency, as in the current case. Among the various problems secondary to vitamin B12 deficiency there is also a hyperpigmentation affecting both the skin and the oral mucosa, prevailing on the dorsal surface of the hands at the knuckles. The hyperpigmentation of the skin, whose pathogenesis is not yet clarified, is histologically due to incontinentia pigmenti. It is one of the most frequent signs of hypovitaminosis occurring in 80% of cases only in subjects with very dark phototype, not in Caucasians; it is often the sign of onset that leads the patient to the doctor. The hyperpigmentation regresses with the administration of vitamin B12.
Case report. A 14 year old male presented weakness and tiredness from one week. He was a pure vegetarian; there was no history of fever or drug intake. Physical examination revealed pallor and hyperpigmentation of the palms (Fig 1). Laboratory investigations showed hemoglobin 6.1 g/dl (normal values =13-17 g/dl) with normal leukocyte and platelet counts; in the peripheral blood there were normocytic normochromic red cells, macro-ovalocytes and hypersegmented neutrophils. His MCV was 102 fl (normal values = 83-101 fl) and serum vitamin B12 levels were decreased to 74.66 pg/ml (normal values = 200-900 pg/ml). His iron and folic acid serum levels were normal. The final diagnosis was vitamin B12 deficiency anemia secondary to inadequate dietary intake; the patient received parenteral mecobalamin followed by tablets. After 4 months of treatment there was normalization of hemoglobin levels and disappearance of hyperpigmentation of the palms (Fig. 2).
Fig. 1
Fig. 2
References 1) Shivbalan S., Srinath M.V. - Reversible skin hyperpigmentation in Imerslund-Grasbeck syndrome. Indian Pediatr. 2013, 50, 973-4, 2013. 2) Takeichi T., Hsu C.K., Yang H.S. et Al. - Progressive hyperpigmentation in a Taiwanese child due to an inborn error of vitamin B12 metabolism (cblJ). Br. J. Dermatol. 172, 1111-5, 2015.
Jagadish Kumar K., Pavan Kumar V., Santhosh Kumar M. JSS Medical College, JSS University, Mysore, India 125
