The classic signs of B12 deficiency are paresthesia, weakness, and a sore, red tongue. In developed countries, this presentation is rare, but is more common in developing nations. Other signs and symptoms of vitamin B12 deficiency include macrocytic anemia, balance and gait disturbances, and irritability. Anorexia and weight loss are common. Malaria and sickle cell anemia are common in this region, but are not consistent with the patient’s symptoms. Iron deficiency does not usually cause paresthesias or tongue pain.