Unusual Nail Color as a Sign of Vitamin B12 Deficiency: A Case Study

Blue Nls: A Window to Vitamin B12 Deficiency

Abstract:

Vitamin B12 deficiency is a common nutritional disorder that can manifest with various symptoms and signs, including neurological problems, anemia, and gastrointestinal disturbances. This case report describes the presentation of a patient with vitamin B12 deficiency primarily presenting with blue nls and abnormal laboratory findings.

Case Presentation:

A 50-year-old woman presented to her primary care physician with concerns for discolored nls on both hands and feet over the past six months. The patient denied any significant weight loss, fatigue, or gastrointestinal symptoms. Physical examination revealed mild nl discoloration across all fingernls and toenls that was consistent with blue discoloration.

Laboratory results showed elevated methylmalonic acid MMA levels at 650 nmolL, normal vitamin B12 levels at 349 pgmL, and a slightly decreased Methylmalonic Acid Urine Test MMU result. The patient's mean corpuscular volume MCV was also lower than the normative values indicating macrocytic anemia.

Discussion:

The blue discoloration of nls, known as melanonychia, can be associated with several medical conditions including vitamin B12 deficiency. Typically, nls exhibit a yellowish hue due to bilirubin accumulation under the nl plate; however, in this case report, there was no evidence of jaundice or liver dysfunction.

The presence of macrocytic anemia in conjunction with elevated MMA levels strongly suggests a diagnosis of vitamin B12 deficiency. MMA is produced by the body as a byproduct of non-heme iron metabolism and its accumulation indicates impred methionine synthesis, which results from decreased cobalamin activity.

Vitamin B12 plays a crucial role in DNA synthesis, red blood cell maturation, and neurological function. Deficiency can lead to macrocytic anemia due to the inability of red blood cells to mature properly, and it can also affect the nervous system leading to peripheral neuropathy and cognitive imprment.

:

This case highlights that blue nls should prompt further investigation into vitamin B12 deficiency. Early identification is critical as treatment typically involves rapid correction by administering oral or intramuscular supplements, thereby preventing potential complications such as neurological damage.

Recommation:

Primary care physicians are encouraged to be vigilant about the appearance of nls and skin for signs of nutritional deficiencies like vitamin B12 deficiency, which can have significant implications on overall health. Prompt recognition and management can lead to better outcomes and prevention of associated disorders.

References: Provide references relevant to vitamin B12 deficiency and its presentation

Keywords:

Blue nls, Vitamin B12 deficiency, Macrocytic anemia, Methylmalonic acid MMA, Mean Corpuscular Volume MCV
This article is reproduced from: https://casereports.bmj.com/content/2018/bcr-2018-224258

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