{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:29:42Z","timestamp":1773008982562,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    deficiency may present with a myriad of symptoms. Rarely, skin hyperpigmentation may be the sole initial manifestation of this micronutrient deficiency, which can easily be overlooked, leading to delayed diagnosis. This case report describes a 32\u2010year\u2010old Ghanaian male who presented with a 4\u2010year history of progressive darkening of the dorsal aspects of the interphalangeal joints of both hands, the palms, and soles of the feet, for which he did not seek immediate medical attention. He later developed a worsening unsteady gait. Neurological assessment revealed mild weakness in both lower limbs, brisk knee reflexes, diminished ankle reflexes, and bilateral extensor plantar reflexes. Additionally, he had decreased sensitivity to fine touch, impaired proprioception, and diminished vibration sense. His gait was ataxic with a positive Romberg\u2019s sign. Laboratory investigations showed macrocytosis with anemia and a markedly reduced serum vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    level. Upper gastrointestinal endoscopy with biopsy identified chronic gastritis. He was diagnosed with vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    deficiency secondary to chronic gastritis complicated by subacute combined degeneration of the cord. Following parenteral repletion of vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    , the skin hyperpigmentation completely resolved. His neurological symptoms also significantly improved. This case report highlights the need to recognize skin hyperpigmentation as a potential initial symptom of cobalamin deficiency, which is critical for early diagnosis and prompt initiation of treatment to prevent debilitating neurological complications.\n                  <\/jats:p>","DOI":"10.1155\/carm\/4459475","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:18:53Z","timestamp":1770877133000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Skin Hyperpigmentation as Initial Manifestation of Vitamin B\n                    <sub>12<\/sub>\n                    Deficiency: A Case of Delayed Diagnosis With Late\u2010Onset Subacute Combined Degeneration of the Cord"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1221-4667","authenticated-orcid":false,"given":"Prosper","family":"Adjei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kingsley Owusu","family":"Manu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paa Kwesi","family":"Asante Addison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Ntow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2019.00093"},{"key":"e_1_2_14_2_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.63311"},{"key":"e_1_2_14_3_2","unstructured":"National Institutes of Health Vitamin B12 Fact Sheet for Health Professionals 2024."},{"key":"e_1_2_14_4_2","unstructured":"SinghN. N. ThomasF. P. andDiamondA. L. Vitamin B12-associated Neurological Diseases 2025."},{"key":"e_1_2_14_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-024-00568-6"},{"key":"e_1_2_14_6_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228258"},{"key":"e_1_2_14_7_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.44017"},{"key":"e_1_2_14_8_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.29008"},{"key":"e_1_2_14_9_2","doi-asserted-by":"publisher","DOI":"10.25259\/ijpgd_116_2023"},{"key":"e_1_2_14_10_2","article-title":"Reversible Hyperpigmentation in Vitamin B12 Deficiency: an Addisonian Mimic in Clinical Practice","volume":"4","author":"Awindaogo R. A. K.","year":"2020","journal-title":"PAMJ Clinical Medicine"},{"key":"e_1_2_14_11_2","doi-asserted-by":"publisher","DOI":"10.3329\/jbcps.v39i1.50461"},{"key":"e_1_2_14_12_2","article-title":"Megaloblastic Anemia","author":"Hariz A.","year":"2023","journal-title":"StatPearls"},{"key":"e_1_2_14_13_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.29225"},{"key":"e_1_2_14_14_2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2024.47.164.43048"},{"key":"e_1_2_14_15_2","doi-asserted-by":"publisher","DOI":"10.1590\/1414-431x2021e11355"},{"key":"e_1_2_14_16_2","article-title":"Subacute Combined Degeneration of the Spinal Cord(Archived)","author":"Qudsiya Z.","year":"2024","journal-title":"StatPearls"},{"key":"e_1_2_14_17_2","unstructured":"GaillardF. LeL. RasuliB.et al. Subacute Combined Degeneration of the Cord 2025."},{"key":"e_1_2_14_18_2","article-title":"Vitamin B12 Deficiency","author":"Ankar A.","year":"2024","journal-title":"StatPearls"},{"key":"e_1_2_14_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/03795721241229503"},{"key":"e_1_2_14_20_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9571072"},{"key":"e_1_2_14_21_2","unstructured":"MeansR. T. J.andFairfieldK. M. Treatment of Vitamin B12 and Folate Deficiencies 2025."}],"container-title":["Case Reports in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/carm\/4459475","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/carm\/4459475","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/carm\/4459475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:38:16Z","timestamp":1773002296000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/carm\/4459475"}},"subtitle":[],"editor":[{"given":"Rafael Scaf","family":"De Molon","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/carm\/4459475"],"URL":"https:\/\/doi.org\/10.1155\/carm\/4459475","archive":["Portico"],"relation":{},"ISSN":["1687-9627","1687-9635"],"issn-type":[{"value":"1687-9627","type":"print"},{"value":"1687-9635","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-11-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"4459475"}}