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

ABSTRACT

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.