Vitamin B12 deficiency masquerading Addison’s disease: a case report of an adolescent male


  • Sudhaa Mani M. Department of Oral Medicine and Radiology, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
  • Yasmeen Ahamed S. Department of Oral Medicine and Radiology, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
  • Nanitha Lakshmi Kavitha Giri Department of Oral Medicine and Radiology, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
  • Jesudasan A. Department Pediatric, Vivekanandha Medical Care Hospitals, Tiruchengode, Tamil Nadu, India



Adolescent, Oral diseases, Oral pigmentation, Treatment of vitamin B-12 deficiency, Vitamin B-12 deficiency


Intraoral pigmentations range from innocuous physiologic pigments to life-threatening malignant conditions. It is at the discretion of the observing clinician to identify the abnormal clinical manifestations and provide necessary intervention. There are controversies about delineating the definite etiology of the pigmentation such as race, exposure to ultra-violet radiation, drug-induced pigmentation post-inflammatory pigments of the oral cavity.


Eisen D. Disorders of pigmentation in the oral cavity. Clini Dermatol. 2000 Sep 1;18(5):579-87.

Lenane P, Powell FC. Oral pigmentation. J Eur Acad Dermatol Venereol. 2000 Nov;14(6):448-65.

Lewis MA. Book Review: Burket's Oral Medicine. In: Martin S, Greenberg, Michael Glick, Eds. Diagnosis and Treatment. 10th ed. BC Decker Inc. Hamilton, 2003: 658.

Adel Kauzman BD, Pavone M, Blanas N, Bradley G. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc. 2004;70(10):682-3.

Marx RE, Stern D. Oral and maxillofacial pathology: a rationale for diagnosis and treatment. Hanover Park, IL: Quintess Pub. Co.,; 2012.

Cawson RA, Odell EW. Cawson's Essentials of Oral Pathology and Oral Medicine. 7th edn, Churchil Livingstone, London. 2002:472.

Rajendran R Sivapathasundaram B. Textbook of Oral Pathology. 7th ed, Elseviers, India. 2012:1000.

Neville BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. 3rd ed. Elsevier Health Sciences; 2015 May 13:928.

Amir E, Gorsky M, Buchner A, Sarnat H, Gat H. Physiologic pigmentation of the oral mucosa in Israeli children. Oral Surg, Oral Medi, Oral Pathol. 1991 Mar 1;71(3):396-8.

Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 deficiency in children and adolescents. J Pediatr. 2001 Jan 1;138(1):10-7.

Van Beynum IM, Den Heijer M, Thomas CM, Afman L, Oppenraay-van Emmerzaal D, Blom HJ. Total homocysteine and its predictors in Dutch children. Am J Clini Nutr. 2005 May 1;81(5):1110-6.

Monsen AL, Refsum H, Markestad T, Ueland PM. Cobalamin status and its biochemical markers methylmalonic acid and homocysteine in different age groups from 4 days to 19 years. Clini Chem. 2003 Dec 1;49(12):2067-75.

Briani C, Dalla Torre C, Citton V, Manara R, Pompanin S, Binotto G, et al. Cobalamin deficiency: clinical picture and radiological findings. Nutrients. 2013 Nov;5(11):4521-39.

Zdilla MJ. Metformin with either histamine H2-receptor antagonists or proton pump inhibitors: A polypharmacy recipe for neuropathy via vitamin B12 depletion. Clini Diabet. 2015 Apr 1;33(2):90-5.

El Toum S, Cassia A, Bouchi N, Kassab I. Prevalence and distribution of oral mucosal lesions by sex and age categories: A retrospective study of patients attending Lebanese school of dentistry. Int J Dentist. 2018;2018.

Wang D, Chen YM, Ruan MH, Zhou AH, Qian Y, Chen C. Homocysteine inhibits neural stem cells survival by inducing DNA interstrand cross-links via oxidative stress. Neurosci Letter. 2016 Dec 2;635:24-32.

Tyagi N, Sedoris KC, Steed M, Ovechkin AV, Moshal KS, Tyagi SC. Mechanisms of homocysteine-induced oxidative stress. American J Physiol Heart Circulat Physiol. 2005 Dec;289(6):H2649-56.

Slominski A, Tobin DJ, Shibahara S, Wortsman J. Melanin pigmentation in mammalian skin and its hormonal regulation. Physiolog Rev. 2004 Oct;84(4):1155-228.

Slominski A, Wortsman J, Plonka PM, Schallreuter KU, Paus R, Tobin DJ. Hair follicle pigmentation. J Investigat Dermatol. 2005 Jan 1;124(1):13-21.

Slominski A, Zmijewski MA, Pawelek J. L‐tyrosine and L‐dihydroxyphenylalanine as hormone‐like regulators of melanocyte functions. Pigment Cell Melan Res. 2012 Jan;25(1):14-27.

Rusher DR, Pawlak R. A review of 89 published case studies of vitamin B12 deficiency. J Hum Nutr Food Sci. 2013 Jan 1;1(2):1008.

Hoffman CF, Palmer DM, Papadopoulos D. Vitamin B~ 1~ 2 Deficiency: A Case Report of Ongoing Cutaneous Hyperpigmentation. Cutis New York. 2003 Feb 1;71(2):127-30.

Agrawala RK, Sahoo SK, Choudhury AK, Mohanty BK, Baliarsinha AK. Pigmentation in vitamin B12 deficiency masquerading Addison's pigmentation: A rare presentation. Ind J Endocrinol Metab. 2013 Oct;17(Suppl1):S254.

Chiang TT, Hung CT, Wang WM, Lee JT, Yang FC. Recreational nitrous oxide abuse-induced vitamin B12 deficiency in a patient presenting with hyperpigmentation of the skin. Case Rep Dermatol. 2013;5(2):186-91.

Demir N, Doğan M, Koç A, Kaba S, Bulan K, Ozkol HU, et al. Dermatological findings of vitamin B12 deficiency and resolving time of these symptoms. Cutan Ocular Toxicol. 2014 Mar 1;33(1):70-3.

Mori K, Ando I, Kukita A. Generalized hyperpigmentation of the skin due to vitamin B12 deficiency. J Dermatol. 2001 May;28(5):282-5.

Niiyama S, Mukai H. Reversible cutaneous hyperpigmentation and nails with white hair due to vitamin B 12 deficiency. Eur J Dermatol. 2007 Oct 19;17(6):551-2.

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. Neurol Ind. 2005 Jan 1;53(1):55.

Gilliam JN, Cox AJ. Epidermal changes in vitamin B12 deficiency. Arch Dermatology. 1973 Feb 1;107(2):231-6.




How to Cite

M., S. M., S., Y. A., Giri, N. L. K., & A., J. (2020). Vitamin B12 deficiency masquerading Addison’s disease: a case report of an adolescent male. International Journal of Research in Medical Sciences, 8(5), 1932–1936.



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