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García-Villa, C. Cabañuz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "García-Villa" "email" => array:1 [ 0 => "agvilla@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Cabañuz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperpigmentación cutánea en el déficit de vitamina B12" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 751 "Ancho" => 2000 "Tamanyo" => 137175 ] ] ] ] "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. The examination revealed hyperpigmentation, with velvety texture, in the axillary folds, knuckles, nipples and facial region, which appeared 1 month before the hospitalization (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The laboratory tests revealed megaloblastic anemia (hemoglobin<span class="elsevierStyleHsp" style=""></span>7.3<span class="elsevierStyleHsp" style=""></span>g/dL, mean corpuscular volume<span class="elsevierStyleHsp" style=""></span>129<span class="elsevierStyleHsp" style=""></span>fl), secondary to vitamin B12 deficiency (plasma cobalamin<span class="elsevierStyleHsp" style=""></span><50<span class="elsevierStyleHsp" style=""></span>pg/mL; range, 197 to 771<span class="elsevierStyleHsp" style=""></span>pg/mL). The gastroscopy found chronic atrophic gastritis. Intrinsic factor antibodies and parietal cells were negative. The previous episode of deep vein thrombosis was attributed to hyperhomocysteinemia secondary to vitamin B12 deficiency. All of the patient's signs and symptoms, including the hyperpigmentation, were resolved in less than a month after the start of cobalamin replacement therapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Skin hyperpigmentation is an uncommon manifestation of vitamin B12 deficiency. The cause of this hyperpigmentation is not exactly known, although it is attributed to the depletion of glutathione, which is involved in intracellular melanin synthesis inhibition. A number of authors have proposed measuring the intensity of knuckle skin hyperpigmentation, using a color scale, as a screening method in regions where the prevalence of vitamin B12 deficiency is high.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-06" "fechaAceptado" => "2017-10-10" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Villa A, Cabañuz C. Hiperpigmentación cutánea en el déficit de vitamina B12. Rev Clin Esp. 2018;218:108–109.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 751 "Ancho" => 2000 "Tamanyo" => 137175 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887417301352/v1_201802230423/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000002/v1_201802230423/S2254887417301352/v1_201802230423/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301352?idApp=WRCEE" ]
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Medicine in Images
Cutaneous hyperpigmentation in vitamine B12 deficiency
Hiperpigmentación cutánea en el déficit de vitamina B12
Servicio de Medicina Interna, Hospital 12 de Octubre, Madrid, Spain