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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
      Figure 1Bilateral palmar hyperpigmentation at presentation and after intramuscular hydroxocobalamin administration.
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