title: Localised Skin Hyperpigmentation as a Presenting Symptom of Vitamin B12 Deficiency Complicating Chronic Atrophic Gastritis.
abstract: 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.
authors.affiliation: Department of Family Medicine & Public Health, Sultan Qaboos University Hospital;
authors.forename: Kawther
authors.initials: K
authors.lastname: El-Shafie
authors.affiliation: Department of Family Medicine & Public Health, Sultan Qaboos University Hospital;
authors.forename: Nafisa
authors.initials: N
authors.lastname: Samir
authors.affiliation: Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman;
authors.forename: Ritu
authors.initials: R
authors.lastname: Lakhtakia
authors.affiliation: Department of Family Medicine & Public Health, Sultan Qaboos University Hospital;
authors.forename: Robin
authors.initials: R
authors.lastname: Davidson
authors.affiliation: Department of Family Medicine & Public Health, Sultan Qaboos University Hospital;
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Waili
authors.affiliation: Department of Family Medicine & Public Health, Sultan Qaboos University Hospital;
authors.forename: Muna
authors.initials: M
authors.lastname: Al-Mamary
authors.affiliation: Department of Family Medicine, Oman Medical College, Sohar, Oman.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Shafee
keywords: Atrophic Gastritis; Case Report; Hyperpigmentation; Oman; Vitamin B12 Deficiency