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Take home message: B12 deficiency can lead to patchy hyperpigmentation of the skin, especially in people with darker skin tones A new case study from Rajasthan, India, reports: 23 year old "strict vegetarian" woman with fatigue, dyspnea on exertion for 3 months severe pallor and darker pigmentation over the knuckles of both hands She had too little hemoglobin, and red blood cells that were too big (typical for B12 deficiency)

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