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It has been reported that patients who are IFA-negative are classified as chronic atrophic gastritis cases.6 In the current patient, the associated Candida infection at the lower part of the oesophagus may also be explained by a B 12 deficiency, as vitamin B group deficiencies have been reported as one of the causes for a Candida albicans infection.7 Pigmentation in B 12 deficiency can also masquerade as pigmentation due to Addison’s disease.4,8–12 There are few reported cases of vitamin B 12 deficiency in which mucocutaneous lesions predate other manifestations.4,8–12 In these cases, the skin changes were characterised by Addisonian brownish-black hyperpigmentation which affected more than one area of the body, including sun-exposed sites, such as the palmar and dorsal aspects of the hands and feet and the knuckles, flexures, tongue, oral mucosa, palmar creases, nails and gluteal region.4,8–12 The pigmentation observed in the current patient differs from these reported cases in that it was localised only to the hands, which may possibly be due to an early diagnosis of the condition

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[DOI] [PMC free article] [PubMed] [Google Scholar] 424.Ahuja, D