Abstract

Pellagra is a nutritional ailment that happens owing to the insufficiency of niacin (vitamin B3), which primarily affects the skin, the GI tract, and the nervous system. It is characteristically categorised with 4Ds, viz. dermatitis, dementia, diarrhea, and death.

The analysis are commonly made on clinical appearances and its instantaneous response to treatment. The pellagra is an easily curable condition which can be serious if not recognized timely, it must be considered in patients with usual clinical signs and symptoms, and treated with suitable dose of vitamin B3. It will result in comprehensive firmness of skin appearances as well as symptoms. 

We present a case of pellagra with cognitive decline, and treated with vitamin B3, and had complete retrieval.

Case Report

A 46-year-old male, came with complaints of thickening and darkening of the skin over the left upper chest and shoulder, epigastric region, both arms and forearm for a period of 5 months. The patient primarily developed deepening of the skin over the left shoulder which slowly involved other sun-exposed areas of the body. He also complained of ulcer over the angle of the mouth for the period of 1 month. The scratches were related with itching and burning sensation on contact to sunlight. He is a lingering alcohol consumer for the past 10 years and consumes 250 ml of alcohol daily. Bowel and bladder habits were normal. There is no history indicative of other nutritional shortages like perioral numbness, foot pain, ataxia, easy bruisability, and join pain.

On over-all physical examination, the patient has paleness with angular cheilitis. His investigation exposed anemia with microcytic hypochromic blood picture and decreased MCV, MCH, and MCHC values.

The opinion of pellagra was made based on the clinical findings of photodermatitis, with mild cognitive decline and with background of chronic alcoholism. The patient was started on nicotinamide based SPF 15 sunscreen moisturizer thrice a day with iron and other multivitamin supplements. The patient improved rapidly after commencing medication, with firmness of skin lesions in a period of 4 weeks. The improvement of the symptoms with nicotinamide maintenances our clinical diagnosis.

Conclusion

Pellagra is a multisystem disease of the skin, and occurs due to the insufficiency of nicotinic acid or its precursor tryptophan. The classical skin appearance will not be in all of the cases. So, the clinicians should be oriented with the information of the unusual presentation of the pellagra in their patient for the early diagnosis and treatment.

Suggested Reading

1. Balamurugesan et al. The Egyptian Journal of Internal Medicine (2021) 33:2 https://doi.org/10.1186/s43162-020-00031-y
2. Arif T, Adil M, Amin SS (2018) Pellagra: an uncommon disease in the modern era- a case report. J Pakistan Assoc Dermatol 28(3):360–363.
3. Gupta SK, Arora AK, Sood N, Kaur S (2014) Pellaagra revisited. Indian Dermatol Online J 5:525