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PubMed2004

Pellagra encephalopathy following B-complex vitamin treatment without niacin.

Pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.

Adult↗
PubMedDate not supplied

A 70-year-old man with isolated weight loss and a pellagra-like syndrome due to celiac disease.

An elderly man was diagnosed with celiac disease, which presented with three notable features: first, presentation at the age of 70 with no prior gastrointestinal symptomatology or positive family history; second, triggering of all symptoms following recent myocardial infarction and infective endocarditis; third, presentation with marked (more than 20 percent) weight loss and pellagra-like skin lesions despite nearly normal examination and laboratory tests. Thus, celiac disease may present as a pellagra-like syndrome in the elderly with predominant weight loss that is enhanced by the related taste disturbances.

Age of Onset↗
PubMed2001

Pellagra: a sporadic pediatric case with a full triad of symptoms.

Pellagra is clinically manifested by a photosensitive dermatitis, diarrhea, and dementia. The full triad of symptoms is usually not well developed in infants and children. We report a case of a 14-year-old boy with classic symptoms of pellagra. All his symptoms responded to treatment with nicotinic acid.

Adolescent↗
PubMed1976

Studies of tryptophan and albumin metabolism in a patient with carcinoid syndrome, pellagra, and hypoproteinemia.

Detailed studies of protein metabolism were undertaken in a patient with pellagra and hypoproteinemia associated with the carcinoid syndrome both before and after treatment. The synthesis of albumin improved from 82 mg per kg per day to 135 mg per kg per day with little change in the daily excretion of 5-hydroxyindole acetic acid. After treatment with nicotinamide the patient made good progress with a complete resolution of the signs of pellagra and protein malnutrition. These results support the hypothesis that a reduced availability of the essential amino acid L-tryptophan may limit the synthesis of albumin and nicotinic acid in patients with the carcinoid syndrome who become anoretic.

Adult↗
PubMed1991

Outbreak of pellagra among Mozambican refugees--Malawi, 1990.

Micronutrient deficiency disorders, including pellagra, have emerged as major problems in refugee populations that depend on international relief assistance for food supplies. This report summarizes an investigation of pellagra that occurred among Mozambican refugees in Malawi during 1990.

Adult↗
PubMed1985

Pellagra in a patient with anorexia nervosa.

A 20-year-old woman was seen with the associated disorders of pellagra and anorexia nervosa, both of which had been present for approximately six months. Treatment with niacin induced resolution of the pellagra skin changes.

Adult↗
PubMed1981

The major psychoses and neuroses as omega-3 essential fatty acid deficiency syndrome: substrate pellagra.

Pellagra was once a major cause of three behaviorally different mental disorders-schizophreniform, manic-depressive-like, and phobic neurotic - plus drying dermatoses, autonomic neuropathies, tinnitus, and fatigue. In this preliminary study all three of the corresponding present-day mental diseases are found to exhibit, statistically, the same pellagraform physical disorders but to ameliorate not so much with vitamins as with supplements of a newly discovered trace omega-3 essential fatty acid (w3-EFA), which provides the substrate upon which niacin and other B vitamin holoenzymes act uniquely to form the prostaglandin 3 series tissue hormones regulating neurocircuits en block. Since present-day refining and food selection patterns, as well as pure corn diets, deplete both the B vitamins and W3-EFA, the existence of therapeutically cross-reacting homologous catalyst and substrate deficiency forms of pellagra are postulated, the first contributing to the B vitamin deficiency epidemics of 50-100 years ago, the second to the more recent endemic "Diseases of Western Civilization" which express in certain genetic subgroups as the major mental illnesses of today.

Adult↗
PubMedDate not supplied

Particular features of clinical pellagra.

The follow-up of an important number of patients during the last three decades has shown a substantial difference between the clinical description of pellagra in the 40's (the triad: dermatitis, diarrhea, dementia) and its clinical aspects today: sun-exposed teguments revealing erythema and rapidly becoming pigmented and parchment like, dried, parched lips, angular stomatitis, lead like sclera fine cornea vascularization; gastro-intestinal disturbances: constipation, unjustified diarrhea, strange migratory abdominal feelings accompanied by ubiquitous dysesthesias. Other characteristics of this form of disease are: unexpressive look, continuously concerned, thoughtful, anxious or frowning, labile mind, headaches, insomnia. Villager's neurosis sometimes may be considered, in an appropriate clinical context, as a facet of nutritional deficiency. It is considered that the "classical" features of pellagra have changed due to: protein ingestion slightly below the lowest normal limit, decrease of strenuous physical activity and some associated diseases (frequently gastrointestinal disorders, chronic alcoholism).

Diet↗
PubMed1998

[Pellagra: diagnosis still valid].

Pellagra, caused by niacin deficiency, was described in 1730 by Casal in Spain and is specially frequent in alcoholics, subjects with malabsorption and mentally ill patients. We report three alcoholic patients (one female) aged 32, 57 and 26 years old, presenting with the typical desquamative and hyperpigmented lesions in exposed areas. One patient also had mental changes characterised by aggressiveness and clouding of consciousness. A diagnosis of pellagra was reached and treatment with nicotinic acid was started with good clinical response in all cases.

Adult↗
PubMed1976

Pellagra.

Pellagra due to malnutrition occurred in an Ottawa women in 1973. She was given a normal diet with supplements of riboflavin, thiamine, niacin and ascorbic acid. The clinical response was striking. Although pellagra is still common in some parts of the world, it is now rare in North America. The disease may occur secondary to malnutrition or malabsorption; inborn errors of metabolism or transport, as in Hartnup disease; deviation of precursors of niacin, as in carcinoid syndrome; or competitive inhibition of niacin incorporation into nicotinamide-adenine dinucleotide, as with administration of isoniazid.

Adult↗
PubMed1997

[The association of Marchiafava-Bignami disease, cerebral pellagra and cerebellar degeneration in an alcoholic patient].

INTRODUCTION: Marchiafava-Bignami disease, cerebral pellagra and alcoholic cerebellar degeneration are a group of diseases included in the alcoholic encephalopathies, although they may also be caused by metabolic or nutritional disorders. The isolated appearance of these diseases usually permits diagnosis during the life of the patient, based on the neuro-radiological findings. However, their combination leads to complex form, with variable neurological expression, which means that precise diagnosis may often be post mortem. CLINICAL CASE: We present a malnourished alcoholic patient with neurological features compatible with alcoholic encephalopathy. The post mortem findings showed lesions typical of alcoholic cerebellar degeneration, cerebral pellagra and Marchiafava-Bignami disease.

Alcoholism↗
PubMed1986

Rectal manifestations of pellagra.

Twenty (44%) of 45 patients with cutaneous pellagra had diarrhoea. Inflammation was seen on sigmoidoscopy in 42 and was severe in 5 (11%), moderate in 4 (9%) and mild in 33 (73%). Six patients (13%) had perianal excoriation. Rectal biopsies taken in all cases showed extensive ulceration in 1 case, moderate to severe inflammation in 16 (36%) and mild inflammation in 18 (40%). Minimal oedema of the lamina propria was seen in 11 (24%) patients. At 5 to 7 days after starting vitamin treatment in nine cases histological changes had returned to normal in 4, improved in 3 and had not changed in 2. Diarrhoea stopped within a week in all cases.

Adult↗
PubMed1991

Pellagra with colitis due to a defect in tryptophan metabolism.

A 9-year-old girl presented with a red scaly rash confined to sun-exposed areas which started at 2 years of age and had the appearance of pellagra. Investigation of urinary tryptophan metabolites following an oral tryptophan load, showed increased excretion of kynurenine and kynurenic acid but reduced excretion of 3-hydroxy-kynurenine, xanthurenic acid and N1-methyl nicotinamide. These results indicated a defect in the hydroxylation of kynurenine, an important reaction in the synthesis of the nicotinamide nucleotide coenzymes, NAD and NADP, from tryptophan. The patient went on to develop severe colitis and psychological changes. All her symptoms responded to treatment with nicotinamide.

Child↗
PubMed1981

Acrodermatitis enteropathica and the relation to pellagra.

A patient with a variant form of acrodermatitis enteropathica (AE) without hypozincemia is presented who showed a rise in plasma zinc and partial improvement on a pancreatic enzyme preparation, apparently because of its content of picolinic acid (PA). Complete recovery occurred on 60 mg zinc (1). This patient has now been treated with zinc PA (equal to only 5 mg zinc) and subsequently with PA. Both maintained elevated plasma zinc levels. Because of the similarity of AE with pellagra and the common origin of PA and nicotinic acid from tryptophan, a hypothesis is presented which suggests that skin manifestations in the two disorders are due to PA deficiency since picolinic carboxylase forms NAD preferentially when there is competition for the common precursor.

Acrodermatitis↗
PubMed1965

Nicotinamide nucleotides in the erythrocytes of patients suffering from pellagra.

1. The nicotinamide nucleotide concentrations in the erythrocytes of subjects suffering from pellagra (pellagrins) were not lower than those in normal subjects, but the ability of erythrocytes to synthesize these nucleotides in vitro was significantly lower in pellagrins. 2. The oral administration of 10g. of l-leucine daily for 5 days depressed the nicotinamide nucleotide-synthesizing ability of erythrocytes both in normal subjects and in pellagrins. This was not accompanied by changes in the nucleotide concentration in erythrocytes. 3. Quinolinic acid brought about a significant inhibition of the synthesis of nicotinamide nucleotides in vitro. Such inhibition was partially overcome by increasing the concentration of nicotinic acid in the medium.

Adult↗
PubMed1998

The "gauntlet" of pellagra.

A 48-year-old alcoholic Filipino man presented to the outpatient department with a 2-year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health. Dermatologic examination revealed a browny-red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry (Fig. 1). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion. A clinical diagnosis of pellagra was made based on the morphology, and treatment with nicotinamide 500 mg daily was instituted. The eruption quickly improved and resolved in 2 weeks (Fig. 2).

Humans↗
PubMed1990

Pathological effects of pellagra on the esophagus.

This study determined the pathological effects of niacin/tryptophan deficiency on the esophagus. Nine patients with severe clinical pellagra and 31 age- and sex-matched controls were assessed. All pellagrins had an esophagitis varying from severe to mild. The esophagitis improved in five patients following six to seven days of vitamin therapy. The relationship between vitamin deficiencies and esophageal cancer is discussed.

Adult↗
PubMedDate not supplied

Pellagra probably due to pyrazinamide: development during combined chemotherapy of tuberculosis.

Pellagra secondary to antituberculous chemotherapy can result from isoniazide therapy, as well as from pyrazinamide treatment. Because of the similarity in structural formulas between pyrazinamide, isoniazide, and nicotinamide, the substrate competition is the mechanism most likely involved. The patient was cured by administration of nicotinamide during continued unchanged chemotherapy of her tuberculosis.

Adult↗