Introduction

We present a clinical case of symptomatic vitamin deficiency typically seen only in resource limited environments or alcoholics, presenting in an adult male with frequent oral intake, but limited diet of prepared foods, as well as co-occurring pernicious anemia.

Clinical Findings

The patient presented with complaints of ascending paresthesia leading to near syncope, lower extremity edema and hyperpigmentation on his anterior legs bilaterally which had been present for years.

Diagnosis and interventions

He was found to have mixed B12, thiamine, and folate deficiency. These were attributed to a combination of nutritional deficiency due to a diet of exclusively cooked foods, and pernicious anemia. He was treated with parenteral and oral vitamin supplementation and noted to improve, but was lost to follow up.

Conclusion

This case highlights the importance of social and nutritional history in health maintenance, as well as the clinical significance of prolonged mixed vitamin deficiency.