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A young woman presented with pellagra. Dietary intake of niacin was in excess of recommended guidelines. She had a low body mass index and was taking a number of alternative remedies. Resolution was rapid with oral nicotinic acid and discontinuation of the remedies.
A 14-year-old boy of Arabic origin presented with a pellagra-like rash and neurological manifestations including ataxia, dysarthria, nystagmus, and coma. There was a striking response to oral nicotinamide. The laboratory findings were not typical of Hartnup disease: aminoaciduris and indicanuria were absent and there was no evidence of tryptophan malabsorption. Tryptophan loading did not induce tryptophanuria nor did it increase excretion of xanthurenic or kynurenic acids. These findings support the possibility of a block in tryptophan degradation. The family history suggests a genetically-determined disorder.
The three main metabolites of niacin have been measured in urine of 10 Mozambican women living in refugee camps in Malawi and displaying clinical symptoms of pellagra. This study, in which a control group was included, showed that the ratio 6PYR/N1MN is well correlated to the occurrence of clinical symptoms of niacin deficiency and constitutes a reliable indicator of vitamin PP status in subjects at risk of this deficiency.
The third in a series of highlights from public health classics in Spain features Gaspar Casal (1680-1759), who discovered pellagra, the leading deficiency disease, in nosological terms, in his surrounding environment.
We report two cases of nutritional deficiency with skin symptoms associated with excessive intake of wine and beer, causing respectively pellagra and zinc deficiency. Supplementation with niacin and zinc had a prompt effect on the skin changes. These cases emphasize the importance of keeping nutritional deficiencies in mind in patients with inadequate nutrition and alcohol abuse.
We report a peculiar case of hemorrhagic pellagra in an exhausted Albanian refugee who had walked for 3 days under sunny skies on his way from his country to Greece. The peculiarities of the case are the fulminant course of the disorder; the "terrifying" appearance of the patient (initially he was admitted to an emergency unit); the gangrenous appearance of the hemorrhagic lesions of the palms and fingernails; the disturbed hepatic function that gradually returned to normal; and the absence of a history of alcohol consumption, alcohol malabsorption, or drug intake.
A patient with tuberculous meningitis developed a pellagra-like skin eruption after treatment with isoniazid. Administration of the drug was continued, and a topical preparation of niacinamide (nico-tinamide) was applied to one half of the face and the back of one hand. The areas treated responded rapidly, and subsequently all affected areas of the patient were treated, with almost complete resolution of the rash. At the same time, there was noticeable improvement in the patient's depression and apathy. We suggest that all of these changes could be due to percutaneous absorption of niacinamide.
The case of a mentally handicapped female patient is presented who developed typical pellagra with dermatitis, diarrhoea and mental alteration following a long-term antiepileptic treatment with phenytoin, ethosuximide and valproic acid. In addition, she had a deficient meat intake. A course of treatment with multivitamins proved successful in resolving the symptoms within 2 weeks.
A 60-year-old woman treated by maintenance haemodialysis refused to take part of the usual vitamin supplements for many years. After an intercurrent illness with profound malnutrition, she developed a paranoid delirium and some behavioural disorders; concomitant diarrhoea and a skin rash were noted. Parenteral nicotinamide (500 mg/day) resulted in a complete recovery from the mental disorders after five days. Other causes of mental disturbance as a result of dialysis could be ruled out. However an asymptomatic underlying hypothyroidism may have been one of the conditioning factors as well as the failure to administer nicotinamide supplements during an acute illness. Neurological pellagra could thus be considered as a rare but reversible cause of mental disorders in patients on maintenance haemodialysis.
A new hereditary defect of tryptophan metabolism is described in a Sudanese family with a high degree of consanguinity. It has an autosomal recessive pattern of inheritance. The condition manifests as a pellagra-like skin rash within 8 weeks after birth, with signs of cerebellar ataxia and developmental retardation. Cataracts develop early, and to date none of the ten affected children has survived beyond 2 years of age. Biochemically, the condition is characterized by an apparent impairment of the ability to synthesize quinolinic acid and nicotinamide nucleotides from tryptophan, which might be due to abnormally high activity of the enzyme picolinate carboxylase.
We report on two cases of pellagra with toxic parenchymal liver defect which developed after abuse of a combined anodynic medicament. The disease was probably caused by 1-phenyl-2,3-dimethyl-4- methylpyrazolon ( Morazon ). Two similar cases from the literature have been attributed to the intake of this medicament. Possible pharmacological effects of Morazon are discussed.
This paper provides an historical account of the epidemiological research which resulted in the elucidation of pellagra and those mental disorders related to it. The implications of this work for clinical research in psychiatry are discussed.
A 32-year-old man with chronic alcoholism over 10 years developed skin eruptions, dark-red tongue and severe watery diarrhea, followed by weakness of bilateral lower extremities. Physical examination revealed hyperpigmented skin eruptions with scales on the dorsa of his hands and extensor aspects of his forearms. Neurological examination showed proximal muscle weakness of both lower extremities, hyperactive knee and ankle jerks, positive Chaddock reflexes and stocking type sensory disturbances. Laboratory data revealed elevation of myolytic enzyme, hypokalemia and decrease of niacin level in the blood. Diagnosis of hypokalemic myopathy and pellagra was made. With the correction of serum potassium level, muscle weakness improved rapidly and with the supplement of niacin, other physical signs and symptoms improved. In this case hypokalemic myopathy could be attributed to the alcoholic malnutritional state such as pellagrous diarrhea, malnutrition, malabsorption and others.
Alcoholic pellagra-encephalopathy is an underestimated entity, which is characterized by alteration in the level and content of consciousness, marked oppositional hypertonus and myoclonus. This entity should be included in the differential diagnosis of encephalopathy in ethanol abusers. The spontaneous course is potentially lethal. Therapy consists of substitution of nicotinic acid in the form of nicotinamide. It is emphasized that any chronic ethanol abuser with neurological symptoms should receive substitution of all B-group vitamins including nicotinamide.
In the civilized world the traditional causes of pellagra such as hunger, malnutrition are disappeared, but the disease has not disappeared after all. In the well developed countries the current etiologic causes are the following: alcoholism, psychiatric disorders, diseases causing cachexy, malabsorption and some drugs. In the case reported by the authors the malnutrition, accompanying the chronic alcoholism was the cause of the diarrhoea, dementia and dermatitis. The correct diagnosis was established after four years of repeated psychiatrical and medical treatment.
A patient who was treated with isoniazid and who developed pellagra is presented. Vitamin B supplements did not help, but the patient's condition improved when isoniazid treatment was stopped.
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