Pellagra induced psychosis: a rare presentation

Pellagra is a nutritional deficiency disease associated with low levels of niacin (vitamin B3). Neuropsychiatric symptoms are rare and are difficult to be diagnosed by clinicians in a timely manner. A 35 years old male was brought with complaints of generalized weakness, decreased appetite and work impairment since past 4 years. Scaly and itching skin rashes have also been present since 3 months followed by hearing voices, suspiciousness and agitated behaviour since one month. On examination, he had pruritic skin rashes over hands which extended over face and neck. His diet comprised mainly of jowar and maize and had history of occasional alcohol use. With an initial diagnosis of psychosis, the patient was started on oral olanzapine. Laboratory and imaging investigations were within normal limits. Dermatology referral confirmed pellagra clinically. The patient was started on injectable multivitamins for 14 days and later shifted to oral multivitamins. Patient showed significant improvement in his skin and neuropsychiatric symptoms. Present case suggests that physicians need to remain vigilant because it is easy to overlook such patients. Pellagra has an insidious onset and psychiatric symptoms appear rare and late in the course when disease is allowed to progress.

Pellagra affecting a patient with Crohn's disease

Abstract: Pellagra is a nutritional disease caused by a deficiency of niacin. It may lead to death if not identified and treated timely. We review the literature and report a female patient presented with clinical features of pellagra as a complication of Crohn's disease.

Dyssebacia:An Early Cutaneous Marker of Niacin Deficiency

Dyssebacia is the name coined to describe numerous plugs of inspissated sebum projecting from dilated orifices of sebaceous glands. This is a case series report of 12 patients who presented to our department with complaints of asymptomatic skin lesions which started first in lower part of nose followed by involvement of entire nose, cheeks and forehead .On examination there were multiple yellow plugs of sebum projecting out from follicular orifices resembling those of shark skin. Dermoscopic examination and Urinary levels of Niacinamide levels in urine were estimated in few cases. Based on history, clinical examination and laboratory, Diagnosis of dyssebacia was made and patients were started on niacinamide following which there was improvement in lesions in 8 of the 12 patients within two to four weeks. Diagnosis of pellagra is based on clinical criteria. Dyssebacia can be the early cutaneous marker of niacin deficiency. Thus in this context detection of dyssebecia acts as a primeval marker in diagnosis of pellagra, which still exists in epidemic proportions in many countries.

Pelagra: enfermedad antigua y de actualidad / Pellagra: an old disease and the present times

Fundamento: la pelagra endémica ha sido erradicada en la mayor parte del mundo, desde hace más de 50 años. En la actualidad existen casos esporádicos con dificultades socioeconómicas, dietas inadecuadas, alcoholismo y otras enfermedades que bloquean la absorción de la niacina. Objetivo: exponer un caso clínico de pelagra. Caso clínico: paciente masculino, blanco de 35 años de edad, desocupado, alcohólico crónico que ingresa por una dermatitis, diarreas y cuadro psiquiátrico. Los exámenes practicados arrojan resultados inespecíficos. Conclusiones: la pelagra no es una enfermedad de difícil diagnóstico, no obstante, algunas veces pasa inadvertida, fundamentalmente por su rara incidencia; es una enfermedad curable, pero si no se inicia el tratamiento oportunamente puede llevar a la muerte. El diagnóstico se establece por los antecedentes, la clínica y la respuesta a una dieta balanceada, con adición de ácido nicotínico o nicotinamida y complejo B.

Background: endemic pellagra was eradicated in most part of the world more than 50 years ago. Nowadays, there are sporadic cases of patients with socioeconomic problems, inadequate diets, alcoholism, and other diseases that block the absorption of niacin. Objective: to present a clinical case of a patient with pellagra. Clinical case: a thirty-five-year-old white male patient with problems of chronic alcoholism that was admitted in the hospital because of dermatitis, diarrhea, and psychiatric manifestations. The tests made to the patient did no show any specific result. Conclusions: pellagra is not a disease of difficult diagnosis; nevertheless, it sometimes goes unnoticed due to its rare incidence. It is a curable disease but if the treatment does not start at the appropriate time it may cause death. The diagnosis is established according to the antecedents, the clinic, and the response to a balanced diet together with niacinamide, niacin, and complex of vitamins B.

Pellagra in association with hallucination and over-salivation.

A 33 yr old African female, living in Makkah, presented to ER with decreased LOC & diarrhoea which was observed by the attending nurse with no more available history .On examination: she was afebrile; Pulse rate was 100 bpm, BP 90/60 mmHg, R/R 18 breaths/min, O2 sat. 98% on room air. She was disoriented having hallucination, underweight, dehydrated, pale. She was diagnosed as acute confusional state, and she received IVF, PRBC, and correction of electrolytes. Patient has received empirical antibiotics since admission and for 3 days, and conservative treatment but has not improved yet! On the 4th day of admission, niacin deficiency was suspected. Therefore, niacin was started at dose of 100 mg BID per oral. By the 6th day of the hospital stay, patient had become oriented, communicating, with no diarrhoea, and the skin lesion started to improve. In conclusion, this case calls attention to pellagra when considering the differential diagnosis of hallucination and oversalivation

Pellagra in patient with schizophrenia: a case report and review of literature

Background: Pellagra, called the disease of 4D’S- dermatitis, diarrhoea, dementia and death, is seen in patients of chronic alcohol dependence, mal absorption syndrome, and psychiatric illnesses like schizophrenia. Mostly a clinical diagnosis, its treatment includes balanced diet and niacin supplementation. There are hardly any case reports about pellagra in schizophrenia patients. Case description: A young Asian woman with complaints of abusing and assaulting, talking to self since three years and loose motions since fifteen days presented to psychiatric outpatient department with signs of dehydration, sharply defined symmetrical, desquamating rash in the neck area and in the sun exposed parts of forearms and legs with mental status examination findings of muttering to self, impaired recent and immediate memory and inability to do simple calculations. Patient showed significant improvement with supportive therapy, antipsychotics, niacin supplementation and balanced diet. Discussion: Pellagra can be seen in psychiatric illnesses like alcohol dependence syndrome, eating disorders and schizophrenia. It occurs along with other vitamin deficiencies which improve with medication and balanced diet. Conclusions: Early identification of vitamin deficiency along with proper education to patients and family regarding the need of balanced diet and adequate vitamin supplementation will prevent further complications. Thus, pellagra seen in schizophrenia patients requires medication and balanced diet.

Lipomatose simétrica benigna e pelagra, associadas ao alcoolismo / Benign symmetrical lipomatosis and pellagra associated with alcoholism

A 42-year-old male patient, alcoholic, presented showing signs of tumors in the neck and around the shoulders, scaly, erythematous-violaceous lesions and some bullous lesions in sun-exposed areas of upper and lower limbs. Based on clinical features, laboratory tests and imaging studies we have established the diagnosis of pellagra associated with benign symmetrical lipomatosis, both justified by chronic alcoholism. Treated with intravenous B-complex and oriented about the importance of alcohol withdrawal, the patient showed complete remission of skin lesions, but with no change in the lipomatosis.

Paciente masculino, 42 anos, etilista crônico, apresentando quadro de tumorações em região cervical e ao redor dos ombros, lesões eritemato-violáceas, descamativas e algumas lesões bolhosas, nas áreas fotoexpostas dos membros superiores e inferiores. Baseado no quadro clínico e nos exames complementares, foi estabelecido o diagnóstico de pelagra associada à lipomatose simétrica benigna, sendo ambos os quadros justificados pelo etilismo crônico. Tratado com reposição de complexo B intravenoso e orientado quanto à importância da abstinência alcoólica, apresentou remissão completa do quadro cutâneo, porém sem alteração da lipomatose.

Pelagra. Presentación de caso interesante / Pelagra. An interesting case report

Se presenta el caso de un paciente masculino de 41 años de edad, con antecedentes de alcoholismo. Acude a la consulta por tener manchas en la piel de los brazos, manos, porción superior del tórax, cuello, genitales externos, muslos y pies. Las manchas en la piel se incrementan con la exposición al sol. El paciente además presentó diarreas líquidas abundantes. Se muestran las fotografías con las alteraciones clínicas de un caso de pelagra. Fue tratado con ácido nicotínico, y complejo vitamínico; egresa con una mejoría ostensible de la enfermedad.

A 41 year-old male patient with a history of alcoholism attended to the consultation presenting skin stains in arms, hands, superior portion of thorax, neck, external genitals, thighs and feet. The skin stains augmented with sun exposure. The patient also had abundant liquid diarrheas. Pictures presented the clinical alterations of a pellagra case were shown. Nicotinic acid and vitamins were the treatment followed; the patient improved and was discharged.

Alcohol-Related Neurologic Disorders: Ten Years of Experiences

Alcohol-related disorders are among the most costly health problems worldwide. Ingested alcohol is mainly metabolized by an oxidative pathway in the liver. Alcohol and its metabolic products (e.g., acetaldehyde and reactive oxygen species) have toxic effects on multiple organs, especially the nervous system. The diverse mechanisms of alcohol-related neurologic disorders include the direct toxic effects of alcohol, the alcohol withdrawal effect, nutritional deficiency secondary to alcoholism, and abnormalities of serum electrolytes and osmolality. We analyzed 156 cases of alcoholrelated neurologic disorders among admitted patients that had been referred in Korea during the previous 10 years. The duration of alcohol consumption ranged from 0.5 to 47 years (mean=17.8 years) and the mean amount of alcohol intake per day was 245.5 g. The 156 patients had the following diseases: Wernicke's encephalopathy (n=81, 51.9%), peripheral neuropathy (n=68, 43.6%), delirium tremens (n=59, 37.8%), Rum fit (n=31, 19.9%), pellagra encephalopathy (n=29, 18.6%), Korsakoff's psychosis (n=22, 14.2%), cerebellar atrophy (n=11, 7.0%), and alcoholic myopathy (n=6, 3.8%). We report on these cases and review the literature on alcohol-related neurologic disorders.

A Case of Pellagra that Initially Mimics Vibrio Sepsis / 감염과화학요법

Pellagra is a disease caused by a deficiency of niacin. It is usually found among chronic alcoholics in Korea. Dermatitis, dementia and diarrhea are characteristic symptoms of pellagra. Vibrio sepsis is due to a virulent, gram-negative rod infection caused by Vibrio vulnificus. It is generally acquired in coastal areas near warm water. Underlying disease and initial clinical presentations of pellagra are very similar to that of vibrio sepsis. Herein, we report a case of pellagra that initially mimicked vibrio sepsis.

A Case of Pellagra that Initially Mimics Vibrio Sepsis / 감염과화학요법

Pellagra is a disease caused by a deficiency of niacin. It is usually found among chronic alcoholics in Korea. Dermatitis, dementia and diarrhea are characteristic symptoms of pellagra. Vibrio sepsis is due to a virulent, gram-negative rod infection caused by Vibrio vulnificus. It is generally acquired in coastal areas near warm water. Underlying disease and initial clinical presentations of pellagra are very similar to that of vibrio sepsis. Herein, we report a case of pellagra that initially mimicked vibrio sepsis.

Two Cases of Pellagra in Alcoholics / 대한피부과학회지

Pellagra is a chronic wasting disorder characterized by 3 clinical distinct symptoms; dermatitis; dementia; and diarrhea. It results from a marked cellular deficiency of water-soluble vitamin B3, also called niacin. Dermatitis begins as an erythema and shows bilateral symmetrical eruption at cutaneous sites of solar exposure. Herein we report 2 cases of pellagra in chronic alcoholics.

A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis / 결핵및호흡기질환

A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis Pellagra is a disease caused by a deficiency of nicotinic acid or niacin. It is mostly found among people eating corn-based diets in parts of China, Africa and India. It is also induced by drugs, such as isoniazid or 5-fluorouracil. Isoniazid inhibits the conversion of tryptophan to niacin and may induce pellagra, particularly in poorly nourished patients. Pellagra should be suspected whenever tuberculous patients under the treatment with isoniazid develop mental, neurological or gastrointestinal symptoms, even in the absence of typical skin changes. Herein, our experienced of a case of pellagra induced by isoniazid during treatment of pulmonary tuberculosis is reported. The patient was referred due to a skin rash and drowsy mental status. Her skin lesion developed during treatment for pulmonary tuberculosis. Her symptoms were improved after discontinuation of antituberculous agents and on the administration of nicotinamide.

Alcoholic pellagra encephalopathy combined with Wernicke disease

Clinical and postmortem findings of a case that had combined alcoholic pellagra encephalopathy and Wernicke disease are described. This 51-year-old malnourished and chronic alcoholic man presented with progressive mental deterioration, pellagra dermatitis, hypertonus of the neck and other musculatures, myoclonic jerks with bizarre involuntary movements, in addition to total external ophthalmoplegia and gait disturbance. After administration of multivitamins, including thiamine and nicotinamide, these neurologic abnormalities were dramatically improved in a few days. However, the patient died thereafter because of sepsis associated with pneumonia. Postmortem examination revealed marked abnormalities in CNS, characterized by diffuse atrophy of gray matter and widespread neuronal degeneration and characteristic central chromatolysis in pontine nuclei, dentate nuclei, cranial nerve nuclei in the brain stem, Betz cells of the cerebral cortex, and Clarke's column and anterior horn cells of the spinal cord. There were also atrophy and gliosis of the mammillary bodies, degeneration and vascular proliferation of periaqueductal gray matter, and massive gliosis around the third ventricle. These neuropathological changes were compatible with symptoms of both alcoholic pellagra encephalopathy and Wernicke's disease, but they were also strongly suspected on clinical grounds.