Patient’s palms before starting treatment
Maharajh, Teelucksingh / The New England Journal of Medicine, 2022
Physicians in Trinidad and Tobago have described excessive darkening of the skin in a black man. The patient has increased melanin synthesis due to B12-deficiency anemia, and due to this, the color of the feet and palms has changed. Doctors diagnosed him with pernicious anemia, which is most often accompanied by fatigue, shortness of breath and dizziness. Darkening of the skin, especially in the absence of other symptoms, is rare with it. Happening described v The New England Journal of Medicine.
Anemia occurs due to a decrease in the hemoglobin content in erythrocytes and usually manifests itself with symptoms of tissue hypoxia: weakness, fatigue, shortness of breath and headache. Also, depending on the cause of anemia, it may be accompanied by additional symptoms: jaundice with destruction of red blood cells or impaired sensitivity of nerve fibers in case of vitamin B12 deficiency. In addition, very unusual symptoms occur in rare cases. So, with pernicious anemia (vitamin B12 deficiency), due to an increase in the synthesis of melanin in melanocytes, the skin and mucous membranes darken. The exact mechanism for the development of hyperpigmentation is unknown, but meets it is only in 10 percent of patients, so doctors often miss this symptom.
A case of pernicious anemia, which manifested itself only as hyperpigmentation of the skin, but helped to identify the anemia in a timely manner, was described by doctors Sandeep Maharajh and Surujpal Teelucksingh of the University of the West Indies in Trinidad and Tobago. They were approached by a 59-year-old black man complaining of darkening of the skin on his feet and palms. Symptoms began to appear in him regarding a year ago, but at first he did not attach importance to them and associated them with his work – he worked as a tiler. On examination, doctors found areas of hyperpigmentation on his tongue, as well as darkening of his feet and palms. Blood tests revealed a decrease in hemoglobin levels and an increase in red blood cell volume, as well as a slight decrease in the number of platelets and leukocytes.
Hematologists suspected that the patient had pernicious anemia associated with vitamin B12 deficiency. With this disease, red blood cells become abnormally large, since they need this vitamin for full development. Vitamin B12 values in the patient’s blood were five times lower than normal values (40 picograms per milliliter at a rate of 200-1100 picograms per milliliter). When doctors began to look for the cause of anemia, they found antibodies in the man to Castle’s intrinsic factor, which the stomach produces. This compound binds vitamin B12 from food, and then the vitamin complex with Castle’s intrinsic factor is absorbed in the ileum.
The doctors concluded that the man had autoimmune gastritis, and to correct the anemia, they prescribed intramuscular administration of vitamin B12 to him, since the patient’s stomach might not absorb it naturally. Usually, when the vitamin deficiency is replenished, hyperpigmentation disappears, which happened in a man following four months of treatment.
Patient’s palms 4 months following the start of treatment
Maharajh, Teelucksingh / The New England Journal of Medicine, 2022
Changes in the color of the skin and mucous membranes often indicate a malfunction in the body. For example, in an American, due to antibodies to an enzyme involved in the synthesis of adrenal hormones, turned blue language. The color change turned out to be reversible, but the woman will have to take hormone replacement therapy for life.
Anastasia Kuznetsova-Fantoni
