A 79-year-old woman visited with a 3-week history of tingling sensation of the tongue. Physical examination showed smooth back ground of tongue with scattered reddish lesions (Fig. 1A). Results of laboratory testing were as follows: leukocyte count, 5330 cells/mm3 (reference range, 3300 to 8600); hemoglobin concentration, 8.8 g/dL(reference range, 11.6 to 14.8); mean corpuscular volume, 133.2 fL (reference range, 83.6 to 98.2); ferritin, 122.9 ng/mL reference range, 12.0 to 60.0) and undetectable vitamin B12 level (<50; reference range, 180 to 914 pg/mL).
