Vitamin B12 Deficiency: In the Palm of One's Hands

      A 54-year-old Trinidadian woman of South Asian descent presented with a 6-month history of fatigue, decreased appetite, weight loss, darkening of her hands (Figure 1), and numbness in her limbs.
      Figure 1Bilateral palmar hyperpigmentation at presentation and after intramuscular hydroxocobalamin administration.
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