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High doses of B12, often used to treat deficiencies, may cause side effects such as headaches, nausea, diarrhea, fatigue or weakness, and tingling in the hands and feet

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Warnings: Patients with early Leber's disease (hereditary optic nerve atrophy) may experience severe and rapid optic atrophy when treated with vitamin B12. Additionally, treating severe megaloblastic anemia with vitamin B12 can lead to fatal hypokalemia due to increased erythrocyte potassium requirements

Histopathologic examination shows many dendritic melanocytes and processes containing melanin in all strata of epithelium