Gallbladder cancer (GBC) is relatively rare and usually has vague clinical presentation. Vitamin B12 (Cobalamin [Cbl]) deficiency is well recognized clinical entity, in contrast, elevated Cbl remains largely unknown and underestimated in practice. We report an elderly patient who presented with generalized weakness. She found to have elevated serum Cbl which raise the suspicion for malignancy. Subsequent imaging studies and tissue biopsy led to diagnose gallbladder adenocarcinoma. Elevated Cbl has been associated with increased risk of subsequent diagnosis of cancer. In addition, elevated Cbl levels in cancer patients have a strong predictive value for mortality, frequent metastases, and poor prognosis. In this case, the incidental finding of high Cbl level led to the diagnosis of serious illness which could otherwise present in a more advanced stage.
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