We herein report on four patients with glossitis induced by vitamin B
12 (VB
12) deficiency. Of the four patients, who complained of glossal pain and who had on prior history of medical consultation (patient A, an 83-year-old female; patient B, an 81-year-old female; patient C, a 59-year-old female; patient D, a 68-year-old male), patients C and D had undergone gastrectomy. In patients A and B, anti-parietal cell antibody was elevated to>80, and atrophic gastritis was ascertained by endoscopic examination. Red blood cell counts were 336, 192, 382, and 358×10
4/μl, and hemoglobin levels were 12.6, 8.2, 12.8, and 12.7g/dl, in patients A, B, C, and D, respectively. Mean cell volume (MCV) increased to 106 to 128μ
3 in three patients, although MCV only slightly elevated in patient C (103μ
3). The levels of serum VB
12 in patients A, B, C, and D were 48, 23, 8, and 110 pg/ml, respectively. With these findings, glossal pain thresholds and salivary flow rates (SFR) were largely decreased in all of the patients. The patients were treated with intravenous/oral VB
12, and all of them except patient A were given oral iron (Fe). With treatment for about 3 weeks, glossal pain disappeared, and reformation of the glossal papillae was observed, in parallel with increases of serum VB
12 levels. The improvement of the glossal condition was also supported by increases of pain thresholds and nonstimulated SFRs. These clinical findings indicate that VB
12 deficiency may induce glossal pain as the first symptom, accompanying decreases of the glossal pain threshold, non-stimulated SFR, and the serum Fe level, and that estimation of the serum VB
12 level and MCV is required for diagnosis of glossal pain, especially in patients with a history of total gastrectomy.
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