Beta-carotenemia: the lurking yellow?

Abstract

Beta carotenemia is a medical condition which presents with yellowing of palms and soles, whilst characteristically sparing oral mucosa and the conjunctiva. Although historically benign, it often causes anxiety among patients and can lead to unwarranted investigations at the hospital, hence the need to appreciate its diagnosis and management. Our report details a case of a rare diagnosis of the condition, the investigation channels and subsequent follow up. This was a hemodynamically stable 35-year-old female without known comorbidities, with a 2-month painless progressive yellowing of palms and soles, without stigmata for liver injury, thyroid disease, diabetes, or recent history of travel. Her neurologic and abdominal assessments were normal but had an obvious yellow tinge on her palms and soles. Her organ system workups were all normal, as was the random sugars, but had moderately elevated beta carotene levels. She was diagnosed with symptomatic beta carotenemia and managed conservatively with active reassurance and dietary modifications for 2 months, with remarkable improvement of symptoms. Although repeat beta carotene levels were not done, symptomatic resolution was deemed as sufficient evidence of the treatment impact. Consequently, the case encounter underscored the role of heightened clinical suspicion in the diagnosis of such cases.