# Pernicious anemia presenting with dysphagia and melanoderma: a confusing manifestation

## TL;DR

A 47-year-old man with pernicious anemia showed rare symptoms like difficulty swallowing and skin darkening, which improved with vitamin B12 treatment.

## Contribution

The paper highlights the rare and confusing presentation of pernicious anemia with dysphagia and melanoderma.

## Key findings

- Severe vitamin B12 deficiency was confirmed as the cause of anemia, pancytopenia, dysphagia, and melanoderma.
- Treatment with vitamin B12 supplements led to significant improvement in all symptoms.
- The case underscores the importance of recognizing uncommon symptoms of pernicious anemia for early diagnosis.

## Abstract

Vitamin B12 deficiency is widely recognized as a common cause of anemia. However, symptoms such as dysphagia, melanoderma, and pancytopenia, although less frequent, can also be associated with this deficiency. We report the case of a 47-year-old Caucasian man presented with dysphagia to solids associated to high heart rate, dyspnea and melanoderma. He was diagnosed with severe anemia (hemoglobin 4 g/dl) in association with pancytopenia. Further investigation confirmed that the underlying cause was severe vitamin B12 deficiency secondary to pernicious anemia. Subsequent treatment with vitamin B12 supplements led to a significant improvement in all symptoms. A review of the existing literature corroborated the rarity of severe anemia occurring in conjunction with dysphagia and melanoderma due to B12 deficiency.

Anemia is a condition where your body does not have enough healthy red blood cells. We report the case of a 47-year-old man who presented with difficulty swallowing solid food (dysphagia), a fast heart rate, difficulty breathing (dyspnea), and changes in skin color (melanoderma). After some tests, we diagnosed the patient with severe anemia and low counts of different types of blood cells (pancytopenia). The underlying cause was a severe lack of Vitamin B12, and the specific type of anemia was called pernicious anemia. Subsequent treatment with Vitamin B12 supplements led to significant improvement. Physicians should be aware of uncommon presentations of pernicious anemia to diagnose it early, avoid unnecessary investigations and to initiate rapidly simple and efficient treatment.

Biermer's disease, is an autoimmune disorder specific of the gastric organ.

Dysphagia, melanoderma and pancytopenia are rarely observed in vitamin B12 deficiency.

Treatment with vitamin B12 supplements drastically improves these symptoms.

Physicians should be aware of uncommon presentations of PA to diagnose it early and avoid unnecessary investigations.