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The common systemic features reported were fatigue, glossitis, weight loss and anorexia that was found in 34%, 31%, 27% and 22% of cases respectively.[4] Hyper pigmentation of skin has been reported only rarely as the presenting manifestation of vitamin B12 deficiency as found in this patient.[5] There are only two such Indian reports found in Indian literature.[6,7] After the treatment, hematologic response begins after several days and, moreover, the final hematologic landmark is the blood count, including mean corpuscular volume (MCV) that should be completely normal by the eighth week.[8] The cutaneous manifestation of vitamin B12 deficiency is skin hyper pigmentation, vitiligo, hair changes, and recurrent angular stomatitis

These drugs have poor tolerability, and side effects such as fatigue, cognitive impairment, dizziness, tremor, and electrolyte abnormalities are common, limiting their use

The rest of the stomach is then removed

She has created a registry for physicians to report delayed rashes and is working on one for patients, in order to understand the range of what they can look like and detect any patterns about which rashes might be more worrisome