Clinical Analysis of 26 Patients with Alcoholic Pellagra Encephalopathy

ABSTRACT

We analyzed 26 cases of probable alcoholic pellagra encephalopathy (APE) in the chronic heavy alcoholics, associated in 18 cases (69%( with Wernicke's disease and in 15 cases (58%) with alcoholic peripheral neuropathy. They were all males and their average age was 46 years. Daily average amount of drinking was 220gm and average period of drinking was 21.8 years. Clinical manifestations were dermatitis in 23 cases (88%), dementia in 22 (85%) and diarrhea in 12 (46%), but only 7 case (27%) had full triad. Most striking features of the APE were fluctuating confusion and/or clouding of consciousness, marked oppositional hypertonus, myoclonic jerks, severe muscle guarding or tenderness in the abdomen and long-lasting (2 weeks or more) delirious behavior. Twelve patients died of sepsis or pneumonia (3 untreated, 9 of 23 treated with nicotinamide). In conclusion, APE seems to be a fatal disease if untreated. Therefore, even in absence of dermatitis or diarrhea, APE should be considered in heavy chronic alcoholics who develop the deterioration of mentality, associated with above-mentioned clinical features, and they should be treated with multivitamins including nicotinamide.