Skin Hyperpigmentation as the Presenting Symptom of Subacute Combined Degeneration of the Spinal Cord

Abstract

Vitamin B12 deficiency results in hematological, neurological, and rarely dermatological complications. Subacute combined degeneration of the cord is one of the neurological complications, and usually the presenting symptom is paresthesia. Herein, we report a case of a 46-year-old man with subacute combined degeneration presenting with knuckle hyperpigmentation.

Hyperpigmentation as a Primary Symptom of Vitamin B12 Deficiency: A Case Report

“…Vitamin B12 plays an integral role in the synthesis of DNA; its deficiency results in multisystem complications [ 2 ]. Plasma concentration below 200 pg/ml (148 pmol/L) is considered deficient.…”

“…The deficiency affects all age groups and causes a range of conditions [ 1 ], most commonly affecting the hematological and neurological systems [ 3 ]. The neurological complications include SCD, peripheral neuropathy, and psychiatric changes [ 2 ]. Many mucocutaneous findings, including hair and nail changes and hyperpigmentation, especially of the hands and feet, are associated with vitamin B12 deficiency [ 5 ].…”

“…While 52% of these 26 patients (22% of the total) presented with mucosal changes, glossitis was specifically seen in 31% (19 out of 63), hyperpigmentation of the skin in 19% (12 out of 63), hair changes in 9% (6 out of 63), angular stomatitis in 8% (5 out of 63), and lastly, vitiligo was seen in only 3% (2 out of 63) [ 10 ]. Therefore, regardless of the presence of neurological symptoms, SCD should be suspected in patients with skin hyperpigmentation, as the neurological manifestations can be a late finding [ 2 ].…”

“…The deficiency of vitamin B12 can cause specific skin manifestations, such as hyperpigmentation, vitiligo, angular stomatitis, and hair and nail changes [ 1 ]. However, the most common dermatological manifestation is hyperpigmentation [ 2 ], which often occurs in combination with systemic findings, including macrocytic anemia, pancytopenia, and subacute combined degeneration of the cord (SCD) [ 3 ]. When dermatological features occur in the dissociation of systemic findings, the deficiency of vitamin B12 can be overlooked.…”

Acquired Vitamin B12 Deficiency: Cutaneous Hyperpigmentation and Hepato-Splenomegaly in Megaloblastic Anaemia / Pancytopenia Reported in a 15-Month-Old Boy

“…At the national level, one case was reported in Jeddah, Saudi Arabia in an adult who had developed Spinal Cord Degeneration in conjunction with pancytopenia and evident vitamin B12 deficiency [7] .…”