Pellagra a review exploring causes and mechanisms, including isoniazid‐induced pellagra

Abstract

Pellagra is a clinical syndrome caused by a deficiency of niacin (nicotinic acid) and/or its precursor tryptophan. The cardinal manifestations are 4 D’s: dermatitis, diarrhoea, dementia and in worst case death. Increased use of isoniazid prophylaxis along with antiretroviral therapy in countries where latent tuberculosis is common has been associated with increased presentations with pellagra.

Effect of niacin supplementation on nausea-like behaviour in an isoniazid-induced mouse model of pellagra

“…This syndrome has two types. One type may result from a defect in intake of niacin or tryptophan from the diet (primary pellagra) and the other from a defect in the use of niacin or tryptophan (secondary pellagra) (5). Secondary pellagra is thought to be caused by drugs, alcoholism or disease of the gastrointestinal tract.…”

Novel Quinolone Derivatives: Synthesis and Antioxidant Activity

“…Among major applications of quinoline is synthesis of nicotinic acid (niacin) [1][2][3]. Some derivatives of quinolone, including alcaloids and quinine [4], are isolated from plants and used as synthetic antimalarial drugs including mefloquine, chloroquine and amodiaquine [5].…”

Pellagra Gloves

“…Pellagra is a nutritional disorder caused by a deficiency of niacin and/or its precursor tryptophan. 1,2 Although it is considered an almost eradicated disease in developed countries, pellagra can occur in patients who experience alcoholism, anorexia nervosa, and malabsorptive or metabolic disorders, including Hartnup disease, and in patients treated with isoniazid. 1 The classic syndrome is characterized by the 3 Ds triad of dermatitis, diarrhea, and dementia that if untreated can lead to death (the fourth D).…”

“…1,2 Although it is considered an almost eradicated disease in developed countries, pellagra can occur in patients who experience alcoholism, anorexia nervosa, and malabsorptive or metabolic disorders, including Hartnup disease, and in patients treated with isoniazid. 1 The classic syndrome is characterized by the 3 Ds triad of dermatitis, diarrhea, and dementia that if untreated can lead to death (the fourth D). 1,2 The characteristic erythematous rash occurs in sun-exposed areas such as the neck (Casal collar) and hands (pellagra gloves) due to a photosensitivity reaction.…”

“…1 The classic syndrome is characterized by the 3 Ds triad of dermatitis, diarrhea, and dementia that if untreated can lead to death (the fourth D). 1,2 The characteristic erythematous rash occurs in sun-exposed areas such as the neck (Casal collar) and hands (pellagra gloves) due to a photosensitivity reaction. The neurocognitive impairment could be more consistent with delirium than with dementia.…”