| Although pellagra is a recognized complication of isoniazid therapy, the diagnosis may be overlooked or delayed--sometimes with life-threatening consequences. We report a case of isoniazid-induced pellagra which occurred despite pyridoxine supplementation. Drug withdrawal and supplementation with niacin led to a rapid and sustained clinical improvement. The possible mechanisms of isoniazid induced pellagra are discussed. ( info) |
2/39. A 70-year-old man with isolated weight loss and a pellagra-like syndrome due to celiac disease. An elderly man was diagnosed with celiac disease, which presented with three notable features: first, presentation at the age of 70 with no prior gastrointestinal symptomatology or positive family history; second, triggering of all symptoms following recent myocardial infarction and infective endocarditis; third, presentation with marked (more than 20 percent) weight loss and pellagra-like skin lesions despite nearly normal examination and laboratory tests. Thus, celiac disease may present as a pellagra-like syndrome in the elderly with predominant weight loss that is enhanced by the related taste disturbances. ( info) |
3/39. pellagra in 2 homeless men. pellagra is a nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. Untreated, pellagra is fatal. Two cases of pellagra in contemporary homeless people are described. Complete evaluation supported a clinical diagnosis of pellagra after exclusion of other possibilities. signs and symptoms resolved after institution of niacin therapy and change in diet. Appropriate suspicion for a diagnosis of pellagra requires attention to a combination of socioeconomic and behavioral risk factors for nutritional deficiency. The combination of homelessness, alcohol abuse, and failure to eat regularly--particularly, failure to make use of shelter-based meal programs--may identify people at special risk in contemporary settings. ( info) |
4/39. pellagra: a sporadic pediatric case with a full triad of symptoms. pellagra is clinically manifested by a photosensitive dermatitis, diarrhea, and dementia. The full triad of symptoms is usually not well developed in infants and children. We report a case of a 14-year-old boy with classic symptoms of pellagra. All his symptoms responded to treatment with nicotinic acid. ( info) |
5/39. Acute hemorrhagic pellagra in an Albanian refugee. We report a peculiar case of hemorrhagic pellagra in an exhausted Albanian refugee who had walked for 3 days under sunny skies on his way from his country to greece. The peculiarities of the case are the fulminant course of the disorder; the "terrifying" appearance of the patient (initially he was admitted to an emergency unit); the gangrenous appearance of the hemorrhagic lesions of the palms and fingernails; the disturbed hepatic function that gradually returned to normal; and the absence of a history of alcohol consumption, alcohol malabsorption, or drug intake. ( info) |
6/39. EMLA cream-induced irritant contact dermatitis. BACKGROUND: The Eutectic Mixture of Local anesthetics (EMLA cream) is a topical anesthetic used for providing pain relief in patients undergoing superficial surgical procedures. Cutaneous side-effects have been reported rarely. CASE REPORT: We present a case of irritant contact dermatitis induced by EMLA cream in a 6-year-old boy with wiskott-aldrich syndrome. Our patient showed clinically a well circumscribed patch corresponding to the site of application of the topical anesthetic. Histopathology showed confluent necrosis of keratinocytes in the upper epidermis, a mixed inflammatory infiltrate with priminent neutrophils in the upper dermis, and focal signs of interface changes including basal cell vacuolization and subepidermal cleft formation. CONCLUSIONS: Graft-vs.-host-disease (GVHD), necrolytic migratory erythema, dermatitis enteropathica and pellagra should be considered in the histopathologic differential diagnosis of acute contact dermatitis caused by EMLA. ( info) |
| A patient with tuberculous meningitis developed a pellagra-like skin eruption after treatment with isoniazid. Administration of the drug was continued, and a topical preparation of niacinamide (nico-tinamide) was applied to one half of the face and the back of one hand. The areas treated responded rapidly, and subsequently all affected areas of the patient were treated, with almost complete resolution of the rash. At the same time, there was noticeable improvement in the patient's depression and apathy. We suggest that all of these changes could be due to percutaneous absorption of niacinamide. ( info) |
| Detailed studies of protein metabolism were undertaken in a patient with pellagra and hypoproteinemia associated with the carcinoid syndrome both before and after treatment. The synthesis of albumin improved from 82 mg per kg per day to 135 mg per kg per day with little change in the daily excretion of 5-hydroxyindole acetic acid. After treatment with nicotinamide the patient made good progress with a complete resolution of the signs of pellagra and protein malnutrition. These results support the hypothesis that a reduced availability of the essential amino acid L-tryptophan may limit the synthesis of albumin and nicotinic acid in patients with the carcinoid syndrome who become anoretic. ( info) |
| This case raises many questions about pellagra in the 21st century. Why are so few cases diagnosed in industrialized societies? Are physicians and other health care providers overlooking many cases? Should we treat any "sick" person and those with unexplained skin, mental status changes or gastrointestinal complaints with safe, inexpensive doses of niacin? Should an inexpensive, reliable laboratory test for pellagra be developed? Clearly the quote, "if you keep pellagra in mind, you will recognize it when you see it" is valid. But perhaps that is not sufficient and pellagra is frequently invisible. ( info) |
10/39. pellagra encephalopathy following B-complex vitamin treatment without niacin. pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid. ( info) |