Vitamin B3 is called niacin, an essential nutrient for the human body. In diet, it exists in three forms - niacin, nicotinamide, and nicotinamide riboside and can also be produced from an amino acid - tryptophan in the gut. During the digestive process, these dietary forms of vitamin B3 get converted into nicotinamide adenine dinucleotide (NAD), which behaves as a cofactor and substrate in critical cellular reactions and thus plays a pivotal role in energy metabolism. The deficiency of this particular vitamin in the body, which manifests in different ways, is called Pellagra. We discuss one such case of niacin deficiency presenting with multisystem involvement in a chronic alcoholic.