Cutaneous manifestations of sarcoidosis are present in approximately one-third of the cases. Ichthyosiform lesion is one of the extremely rare cutaneous manifestations of sarcoidosis. It is a uncommon, but specific cutaneous manifestation of sarcoidosis that may precede or appear simultaneously with the diagnosis of systemic sarcoidosis. Approximately 20 cases of ichthyosiform sarcoidosis have been reported in the PubMed database. We report here a case of sarcoidosis with ichthyosiform skin lesions along with central nervous system (CNS) and pulmonary involvement for its rarity and interesting clinical presentation.

Vitamin B12 deficiency presents as megaloblastic anemia with neurological, skin and other clinical manifestations. We present here an interesting case of anemia presenting with generalized weakness and nonspecific symptoms in a female who is a vegetarian. There was acral hyperpigmentation without any other clinical features, Investigations revealed megaloblastic anemia with low vitamin B12 and normal RBC folate levels. The patient improved after blood transfusion and intramuscular vitamin B12 injections and the skin lesions faded away suggesting vitamin B12 deficiency to be the cause of hyperpigmentation, which is an uncommon manifestation. The importance lies in the fact that this cause of reversible hyperpigmentation should be thought of by clinicians to start prompt treatment.