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.

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.

Pelagra / Pellagra

A pelagra (deficiência de vitamina B6) acomete pacientes cronicamente desnutridos emerece destaque por seu envolvimento multissistêmico. É relatado o caso de um paciente de48 anos, sexo masculino, com história de alcoolismo crônico, diarréia, insônia, irritabilidade ediminuição da memória. Ao exame físico, apresentava lesões eritematodescamativas,edemaciadas, simétricas no dorso de ambos os pés e região anterior e posterior das pernas,poupando a área da bermuda e as tiras dos chinelos. Após 20 dias de reposição de niacina ecomplexo B, apresentou melhora significativa das lesões de pele, sem melhora dos sintomasdigestivos e neurológicos. Os aspectos da patogênese, fisiopatologia, diagnóstico diferencial etratamento da pelagra são discutidos. O diagnóstico de pelagra deve ser lembrado em pacientescom lesões de pele e fatores de risco para desnutrição, como pacientes alcoolistas e doentescrônicos.

Pellagra (vitamin B6 deficiency) is seen in chronically malnourished patients and deservesattention because of its multisystemic involvement. We report a case of a 48-year-old malepatient with chronic alcohol abuse, diarrhea, insomnia, irritability and memory impairment. Onphysical examination, there were symmetrical, erythematous, desquamative and edematouslesions on the dorsum of both feet and anterior and posterior aspects of the legs, sparing thearea covered by the shorts and slippers straps. After 20 days of niacin and B complexreplacement, there was marked improvement in skin lesions, but the digestive and neurologicalsymptoms did not improve. Aspects concerning pathogenesis, pathophysiology, differentialdiagnosis and treatment of pellagra are discussed. Diagnosis of pellagra should be consideredin patients with skin lesions and risk factors for malnourishment, such as alcoholic andchronically ill patients.