Santra Gouranga, Paul Rudrajit, Ghosh Sumit Kr, Chakraborty Debojyoti, Das Shubhabrata, Pradhan Sourav, Das Abhishek
J Assoc Physicians India. 2014 Aug;62(8):714-6.
In developing countries like India, nutritional deficiencies are prevalent and hyperpigmentation due to protein energy malnutrition, zinc deficiency and pellagra are common. Indian women, especially vegetarian are prone to vitamin B12 deficiency. Vitamin B12 deficiency can present as anaemia, neurological defect, gastrointestinal symptoms or dementia. Hyperpigmentation as the first presentation of Vitamin B12 deficiency is rare. Our patient, a 45 year-old Hindu vegetarian female presented to us with generalized hyperpigmentation. Examination revealed associated anaemia and peripheral neuropathy. Laboratory investigation confirmed vitamin B12 deficiency. Clinical features along with hyperpigmentation improved with vitamin B12 supplementation. We report this case to highlight this rare manifestation of vitamin B12 deficiency. A high index of clinical suspicion is warranted to diagnose the case. Since India is a country with a large number of potential vitamin B12 deficiency cases, the physicians need to be aware of all the varied manifestations of this vitamin deficiency. In case of hyperpigmentation, nutritional aspect must be ruled out as it is reversible. Early replacement therapy may also help to prevent morbidities like dementia and neuropathy.
在印度这样的发展中国家，营养缺乏现象普遍存在，蛋白质能量营养不良、锌缺乏和糙皮病导致的色素沉着很常见。印度女性，尤其是素食者，容易缺乏维生素B12。维生素B12缺乏可表现为贫血、神经缺陷、胃肠道症状或痴呆。色素沉着作为维生素B12缺乏的首发表现很罕见。我们的患者是一名45岁的印度教素食女性，因全身色素沉着前来就诊。检查发现伴有贫血和周围神经病变。实验室检查确诊为维生素B12缺乏。补充维生素B12后，临床症状以及色素沉着均有所改善。我们报告此病例以突出维生素B12缺乏这种罕见表现。诊断该病例需要高度的临床怀疑指数。由于印度是一个存在大量潜在维生素B12缺乏病例的国家，医生需要了解这种维生素缺乏的所有不同表现。对于色素沉着病例，必须排除营养方面的因素，因为这是可逆的。早期替代疗法也可能有助于预防痴呆和神经病变等疾病。
