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Her symptoms were managed with clindamycin gel and ketoconazole cream, and she had near total resolution of her acneiform eruption 2 weeks after onset

Recommended investigations include: Full blood count with blood film examination Serum vitamin B12 level Serum folate (to exclude combined deficiency) Intrinsic factor antibodies Thyroid function tests (autoimmune association) Consider MMA and homocysteine if diagnosis uncertain and available Neurological examination should be performed in all patients, assessing for peripheral neuropathy, proprioception loss, and signs of subacute combined degeneration of the spinal cord

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[4] Clinical practice typically involves reviewing medication history, assessing liver function, performing a full blood count, and considering haematological or hepatological referral when levels are markedly elevated without clear cause