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Case Reports in Hematology
Volume 2013, Article ID 680459, 5 pages
Case Report

A Reversible Cause of Skin Hyperpigmentation and Postural Hypotension

1Department of Internal Medicine, Howard University, Washington, DC 20060, USA
2Department of Family Medicine, York Hospital, York, PA 17403, USA

Received 22 March 2013; Accepted 22 May 2013

Academic Editors: A. M. Mansour, N. Martinez-Quiles, M. M. Nogueras, M. T. Perez-Gracia, and C. Pignata

Copyright © 2013 Rabia Cherqaoui et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Vitamin B12 deficiency results in neuropsychiatric, hematologic, gynecologic, cardiovascular, and cutaneous manifestations. It is seen most commonly in the elderly, malabsorption diseases  (>60% of all cases), vegans, and vegetarians. Manifestations of pernicious anemia may be similar to Addison disease and may lead to a misdiagnosis. Herein, we report two cases of vitamin B12 deficiency in which clinical features shared many similarities with Addison disease. Both patients presented with progressive darkening of hands and postural hypotension that reversed with replenishment of vitamin B12. Vitamin B12 deficiency should be considered in patients presenting with skin lesions especially with other coexisting autoimmune diseases.