Manifestation of pernicious anaemia as hyperpigmentation of palms and soles

Srinivas Vaddadi, Radha Srinivas Vaddadi


Vitamin B12 deficiency produces various manifestations involving CNS, heart, skin, blood and female reproductive systems. It is seen most commonly in the older individuals, malabsorptive states (>60% of all cases) and vegetarians. Pernicious anaemia may be confused to Addison’s disease as both may present with similar clinical features. Hereby we report a case of pernicious anaemia presenting with dermatological manifestation in the form of deep pigmentation of both palms of and both soles respectively, cortisol levels normal so Addition’s disease ruled out.


Pancytopenia, Biguanides, Pernicious anaemia, Methionine

Full Text:



Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency. Blood. 1990;76(5):871-81.

Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. Canadian Medical Association Journal. 2004;171(3):251-9.

Marcuard SP, Albernaz L, Khazanie PG. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12). Annals of internal Medicine. 1994;120(3):211-5.

Andrès E, Noel E, Abdelghani MB. Vitamin B12 deficiency associated with chronic acid suppression therapy. Annals of Pharmacotherapy. 2003;37(11, article 1730).

Adams JF, Clark JS, Ireland JT. Malabsorption of vitamin B12 and intrinsic factor secretion during biguanide therapy. Diabetologia. 1983;24(1):16-8.

Ganjehei L, Massumi A, Razavi M, Wilson JM. Orthostatic hypotension as a manifestation of vitamin B12 deficiency. Texas Heart Institute Journal. 2012;39(5):722-3.

Ogbuawa O, Trowell J, Williams JT. Hyperpigmentation of pernicious anemia in Blacks. Report of three cases. Archives of Internal Medicine. 1978;138(3):388-9.

Aaron S, Kumar S, Vijayan J, Jacob J, Alexander M, Gnanamuthu C. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Neurology India. 2005;53(1):55-8.

Mori K, Ando I, Kukita A. Generalised hyper pigmentation of B12 deficiency. J Dermatol. 2001;28:282-5.

Tefferi A, Pruthi RK. The biochemical basis of cobalamin deficiency. Mayo Clinic Proceedings. 1994;69(2):181-6.

Cherqaoui R, Husain M, Madduri S, Okolie P, Nunlee-Bland G, Williams J. A reversible cause of skin hyper pigmentation and postural hypotension. Case Reports in Hematology. 2013;2013:680489.