Hidden in the Rash - Alcoholic Pellagra Encephalopathy

Abstract

Pellagra Encephalopathy is a recognised medical condition due to niacin deficiency. Patients with alcohol dependence invariably have vitamin deficiencies, including niacin. Pellagra Encephalopathy can be challenging to diagnose alongside withdrawal delirium. Diarrhoea, skin rashes, memory and attention deficits, paraesthesia and proximal muscle weakness were noted in four patients diagnosed with delirium tremens. Atypical features such as cognitive and neurological deficits were understood as the presentation of pellagra encephalopathy. The presence of neurocognitive symptoms in addition to typical dermatological presentation guided consideration of pellagra encephalopathy comorbid with delirium due to alcohol withdrawal. Subtle neurological symptoms indicative of pellagra encephalopathy may be overlooked in patients with delirium.

Alcoholic pellagrous encephalopathy: a case report on atypical presentation and diagnostic dilemma in alcohol-related disorders

“…Alcoholic pellagrous encephalopathy presents as a niacin deficiency-related condition with characteristic symptoms, known as the ʻ4 D’sʼ: dermatitis marked by rough, red, and sun-exposed areas of the skin becoming inflamed (similar to the above findings), persistent diarrhea, dementia (including memory loss and confusion) more preferably delirium, and potential fatality if left untreated, emphasizing the need for prompt medical intervention 2 , 4 .…”

“…Pellagra is classically recognized for its dermatological features, but pellagrous encephalopathy, a neurological and neuropsychiatric presentation, is a rare and challenging manifestation, particularly when occurring in conjunction with AUD. Alcoholic pellagrous encephalopathy refers to a condition where a person who abuses alcohol develops neurological and neuropsychiatric symptoms due to a deficiency of vitamin B3 (niacin), known as pellagra 2 , 4 . Alcohol is the 11th leading cause of Disability Adjusted Life Years (DALYs) in Nepal.…”