Pellagra: Rekindling of an Old Flame

Delgado-Sanchez, Lisette; Godkar, D.; S, Niranjan

doi:10.1097/mjt.0b013e31815ae309

Cited by 25 publications

(16 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such reports are a timely reminder that pellagra continues to exist in certain malnourished populations in industrialized countries. Moreover, recent reports have suggested that pellagra may be increasing in alcohol-dependent populations and among those positive for HIV in both developing and developed countries [42]. …”

Section: Recent Case Reports: Special Populationsmentioning

confidence: 99%

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Oldham

Ivkovic

2012

Addict Sci Clin Pract

View full text Add to dashboard Cite

BackgroundAlcohol withdrawal delirium (AWD) is associated with significant morbidity and mortality. Pellagra (niacin deficiency) can be a cause of delirium during alcohol withdrawal that may often be overlooked.ObjectivesWe present a three-patient case series of pellagrous encephalopathy (delirium due to pellagra) presenting as AWD.MethodsWe provide a brief review of pellagra’s history, data on pellagra’s epidemiology, and discuss pellagra’s various manifestations, particularly as related to alcohol withdrawal. We conclude by providing a review of existing guidelines on the management of alcohol withdrawal, highlighting that they do not include pellagrous encephalopathy in the differential diagnosis for AWD.ResultsThough pellagra has been historically described as the triad of dementia, dermatitis, and diarrhea, it seldom presents with all three findings. The neurocognitive disturbance associated with pellagra is better characterized by delirium rather than dementia, and pellagra may present as an isolated delirium without any other aspects of the triad.DiscussionAlthough endemic pellagra is virtually eradicated in Western countries, it continues to present as pellagrous encephalopathy in patients with risk factors for malnutrition such as chronic alcohol intake, homelessness, or AIDS. It may often be mistaken for AWD. Whenever pellagra is suspected, treatment with oral nicotinamide (100 mg three times daily for 3–4 weeks) prior to laboratory confirmation is recommended as an inexpensive, safe, and potentially life-saving intervention.

show abstract

Section: Recent Case Reports: Special Populationsmentioning

confidence: 99%

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Oldham

Ivkovic

2012

Addict Sci Clin Pract

View full text Add to dashboard Cite

show abstract

“…1,5,6 Currently, alcoholism seems to be the most common cause of pellagra in developed countries. 7 Chronic alcoholism is often associated with a nutritionally poor diet and malabsorption. Pellagra may also be a complication of anorexia nervosa, in which there is a deficient intake of niacin and/or protein, as well as a deficiency of riboflavin and/or pyridoxine, with both coenzymes implicated in the conversion of tryptophan to niacin.…”

Section: Discussionmentioning

confidence: 99%

A Case of Pellagra Associated With Megaduodenum in a Young Woman

et al. 2012

View full text Add to dashboard Cite

Pellagra is a rare condition that has been known for many years to be related to niacin deficiency. Clinically known as the 4 "D" symptoms for dermatitis, diarrhea, dementia, and even death, skin changes remain one of the most important features of this pathology, leading frequently to the diagnosis. Pellagra is mostly seen in poor populations with a deficient diet; still, it is sporadically observed in developed countries, usually in association with digestive disorders. We report a new case of pellagra in a 29-year-old woman in whom the diagnosis of megaduodenum was made. Megaduodenum is a rare condition that can be idiopathic or secondary to visceral myopathy or neuropathy. Parenteral supplementation with niacin has resulted in a quick response of dermatological and psychiatric symptoms. To our knowledge, no case of pellagra due to megaduodenum has been reported in literature.

show abstract

“…Although rare, it is well documented that pellagra has never been fully eradicated and should not be remembered for its historical significance alone. [61][62][63][64][65][66][67][68][69] As with Wernicke's encephalopathy, pellagra is associated with a classic triad: dermatitis, diarrhea, and dementia, which is well known by the mnemonic ''the three D's.'' 59,69,70 Also, as with Wernicke's encephalopathy, the presence of the triad is far from an absolute: The full triad was found in only 22% of patients in one clinical series, and the classic dermatological findings were found in none of the patients in one large pathology case series.…”

Section: Wernicke's Encephalopathymentioning

confidence: 99%

“…71,73,74 Neurological signs include spastic para-paresis and plegia, extrapyramidal signs, hyperreflexia, plantar extensor responses, myoclonus of the face and extremities, gait abnormalities, gegenhalten, tremor, dysphagia, urinary and fecal incontinence, and seizures. 68,71,[73][74][75] In their classic case series, Jolliffe et al reported a clinical picture consisting of ''clouding of consciousness, cogwheel rigidity of the extremities, and uncontrollable grasping and sucking reflexes.'' 76 The classic dermatological manifestation of pellagra is a symmetrical, sharply demarcated erythematous rash that progresses to vesicles and bullae in sunexposed areas, including the face; dorsal surfaces of the hands and arms; and the front of the neck, forming a broad collar known as ''Casal's necklace''(named for the Spanish court physician who first described the disease).…”

Section: Wernicke's Encephalopathymentioning

confidence: 99%

Rare and Unusual … Or Are They? Less Commonly Diagnosed Encephalopathies Associated with Systemic Disease

Weathers¹,

Lewis²

2009

Semin Neurol

View full text Add to dashboard Cite

Encephalopathy due to hepatic or renal failure, electrolyte disturbances, or the administration of benzodiazepines and narcotics is commonly encountered, well reviewed in the literature, and, therefore, not usually missed. This article focuses on encephalopathies that were previously well described but may be overlooked by modern clinicians, as well as those that are still taught in the classroom but seldom thought of in practice. Due to the presumed relative rarity of these cases and emphasis on the well-memorized "classic" clinical presentations, these often treatable, and perhaps not so rare, encephalopathies due to systemic medical illness may go undiagnosed and untreated. Pancreatic encephalopathy, Wernicke's encephalopathy, and pellagra encephalopathy are reviewed in detail; cefepime and ifosfamide encephalopathies are discussed as examples of specific medication-induced encephalopathies. Septic encephalopathy, central pontine myelinolysis, and fat embolism syndrome are briefly reviewed. The encephalopathies reviewed have the potential for devastating neurological consequences if recognition and, therefore, treatment are delayed. Clinical improvement for many of these syndromes depends on prompt intervention. This article highlights some representative examples of less-commonly diagnosed metabolic and toxic encephalopathies.

show abstract

Pellagra: Rekindling of an Old Flame

Cited by 25 publications

References 5 publications

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

A Case of Pellagra Associated With Megaduodenum in a Young Woman

Rare and Unusual … Or Are They? Less Commonly Diagnosed Encephalopathies Associated with Systemic Disease

Contact Info

Product

Resources

About