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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old man with a history of unprovoked deep vein thrombosis in the left leg 6 months earlier was admitted for asthenia and weight loss that started 6 weeks ago&#46; The examination revealed hyperpigmentation&#44; with velvety texture&#44; in the axillary folds&#44; knuckles&#44; nipples and facial region&#44; which appeared 1 month before the hospitalization &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The laboratory tests revealed megaloblastic anemia &#40;hemoglobin<span class="elsevierStyleHsp" style=""></span>7&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; mean corpuscular volume<span class="elsevierStyleHsp" style=""></span>129<span class="elsevierStyleHsp" style=""></span>fl&#41;&#44; secondary to vitamin B12 deficiency &#40;plasma cobalamin<span class="elsevierStyleHsp" style=""></span>&#60;50<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#59; range&#44; 197 to 771<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#41;&#46; The gastroscopy found chronic atrophic gastritis&#46; Intrinsic factor antibodies and parietal cells were negative&#46; The previous episode of deep vein thrombosis was attributed to hyperhomocysteinemia secondary to vitamin B12 deficiency&#46; All of the patient&#39;s signs and symptoms&#44; including the hyperpigmentation&#44; were resolved in less than a month after the start of cobalamin replacement therapy&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Skin hyperpigmentation is an uncommon manifestation of vitamin B12 deficiency&#46; The cause of this hyperpigmentation is not exactly known&#44; although it is attributed to the depletion of glutathione&#44; which is involved in intracellular melanin synthesis inhibition&#46; A number of authors have proposed measuring the intensity of knuckle skin hyperpigmentation&#44; using a color scale&#44; as a screening method in regions where the prevalence of vitamin B12 deficiency is high&#46;</p></span>"
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March 2018 Cutaneous hyperpigmentation in vitamine B12 deficiency
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Vol. 218. Issue 2.
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Vol. 218. Issue 2.
Pages 108-109 (March 2018)
Medicine in Images
DOI: 10.1016/j.rceng.2017.10.005
Cutaneous hyperpigmentation in vitamine B12 deficiency
Hiperpigmentación cutánea en el déficit de vitamina B12
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A. García-Villa
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agvilla@salud.madrid.org

Corresponding author.
, C. Cabañuz
Servicio de Medicina Interna, Hospital 12 de Octubre, Madrid, Spain
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