1. Pellagra in the Chronic Alcoholic Andy McWilliams Morning Report 4/2/2010

2. Pellagra Defined • Disease of vitamin deficiency • Lack dietary Niacin (Vitamin B3 – a water soluble vitamin) • Still common in the 3rd world • Rarely found in developed countries due to dietary modifications • Must keep on differential for alcoholism, anorexia, malnutrition, malabsorption, and carcinoid syndrome

3. Signs and SymptomsDermatitis, Diarrhea, Dementia • Vague gastrointestinal (GI) symptoms of anorexia, abdominal pain, and vomiting prior to the typical rash or diarrhea • In addition, patients may experience dysphagia secondary to glossitis, change in taste sensation • Spectrum of neurologic symptoms including hallucinations and depression - can progress to delirium and coma if untreated. • Multi-organ system failure

4. The Rash of Pellagra • Bilateral and symmetrical • Usually starts in sun exposed areas • Then classically dorsa of hands, face, neck, and chest. Casal’s necklace – broad band at collar-line • Can have intense pruritis • Starts as well demarcated erythematous patches • Second stage – dry, scaley, hyperkeratotic

5. Pellagra Rash

6. Pellagra Rash

7. Pellagra Rash

8. Acknowledgements and References Julie Joseph and Kamal Kolappa 1. Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. 2004;43(1):1-5. 2. Nogueira A, Duarte AF, Magina S, Azevedo F. Pellagra associated with esophageal carcinoma and alcoholism. Dermatol Online J. 2009;15(5):8. 3. Park YK, Sempos CT, Barton CN, Vanderveen JE, Yetley EA. Effectiveness of food fortification in the United States: the case of pellagra. Am J Public Health. 2000;90(5):727-738. 4. Ishii N, Nishihara Y. Pellagra among chronic alcoholics: clinical and pathological study of 20 necropsy cases. J Neurol Neurosurg Psychiatry. 1981;44(3):209-215. 5. Prousky JE. Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature. Altern Med Rev. 2003;8(2):180-185.