Pellagra is a chronic wasting disorder characterized by 3 clinical distinct symptoms; dermatitis; dementia; and diarrhea. It results from a marked cellular deficiency of water-soluble vitamin B3, also called niacin. Dermatitis begins as an erythema and shows bilateral symmetrical eruption at cutaneous sites of solar exposure. Herein we report 2 cases of pellagra in chronic alcoholics.
Alcoholics* ; Dementia ; Dermatitis ; Diarrhea ; Erythema ; Humans ; Niacin ; Niacinamide ; Pellagra*

A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis Pellagra is a disease caused by a deficiency of nicotinic acid or niacin. It is mostly found among people eating corn-based diets in parts of China, Africa and India. It is also induced by drugs, such as isoniazid or 5-fluorouracil. Isoniazid inhibits the conversion of tryptophan to niacin and may induce pellagra, particularly in poorly nourished patients. Pellagra should be suspected whenever tuberculous patients under the treatment with isoniazid develop mental, neurological or gastrointestinal symptoms, even in the absence of typical skin changes. Herein, our experienced of a case of pellagra induced by isoniazid during treatment of pulmonary tuberculosis is reported. The patient was referred due to a skin rash and drowsy mental status. Her skin lesion developed during treatment for pulmonary tuberculosis. Her symptoms were improved after discontinuation of antituberculous agents and on the administration of nicotinamide.
Africa ; China ; Diet ; Eating ; Exanthema ; Fluorouracil ; Humans ; India ; Isoniazid* ; Niacin ; Niacinamide ; Pellagra* ; Skin ; Tryptophan ; Tuberculosis, Pulmonary*

Pellagra is a disease caused by a deficiency of niacin. It is usually found among chronic alcoholics in Korea. Dermatitis, dementia and diarrhea are characteristic symptoms of pellagra. Vibrio sepsis is due to a virulent, gram-negative rod infection caused by Vibrio vulnificus. It is generally acquired in coastal areas near warm water. Underlying disease and initial clinical presentations of pellagra are very similar to that of vibrio sepsis. Herein, we report a case of pellagra that initially mimicked vibrio sepsis.
Alcoholics ; Dementia ; Dermatitis ; Diarrhea ; Humans ; Korea ; Niacin ; Pellagra ; Sepsis ; Vibrio ; Vibrio vulnificus

Pellagra is a disease caused by a deficiency of niacin. It is usually found among chronic alcoholics in Korea. Dermatitis, dementia and diarrhea are characteristic symptoms of pellagra. Vibrio sepsis is due to a virulent, gram-negative rod infection caused by Vibrio vulnificus. It is generally acquired in coastal areas near warm water. Underlying disease and initial clinical presentations of pellagra are very similar to that of vibrio sepsis. Herein, we report a case of pellagra that initially mimicked vibrio sepsis.
Alcoholics ; Dementia ; Dermatitis ; Diarrhea ; Humans ; Korea ; Niacin ; Pellagra ; Sepsis ; Vibrio ; Vibrio vulnificus

Carcinoid syndrome exhibits a constellation of symptoms typically exhibited by patients with carcinoid tumors that produce neuroendocrine mediators, including serotonin. Carcinoid syndrome is diagnosed by increasing urinary 5-hydroxyindoleacetic acid and manifestations of gastrointestinal tract, respiratory, cardiovascular, and skin involvement, which occurs in <10% of patients. Cutaneous manifestations are flushing, telangiectasias, pellagra dermatitis, and scleroderma-like lesions, which are relatively rare. A 60-year-old woman presented with sclerotic skin lesions on both legs. On examination, a 10x10 cm solid mass was palpable on the right lower abdomen, and she had facial flushing and telangiectasia, but Raynaud's phenomenon was absent. The urinary 5-hydroxyindoleacetic acid was elevated (68.2 mg/day). Abdominal and pelvic CT scans showed a right ovarian tumor which was diagnosed as a carcinoid tumor by CT-guided needle biopsy. Thus, we report, for the first time, a case of carcinoid syndrome with scleroderma-like lesions in a Korean patient. If facial flushing and a scleroderma-like lesion present together, one should consider a carcinoid tumor.
Abdomen ; Biopsy, Needle ; Carcinoid Tumor ; Dermatitis ; Female ; Flushing ; Gastrointestinal Tract ; Humans ; Leg ; Middle Aged ; Pellagra ; Serotonin ; Skin ; Telangiectasis

The authors experienced a case of typical pellagra in 45-year old male. He has been a heavy alcoholic history about 30 years duratian. Well-marginated erythematous created scaly patches, hyperpigmentation and fissures developed on both forearms and both ear lobes, both periorbicular areas, and Casals and klace on the aa0erior neck repeatedly. The skin leaions were aggravated in summers, improving a little in winters from 3 years ago. The psychoneurotic symptoms, neurologic disturbances, and GI troubles accompanied the skin lesions. Diagnosis was made by the characteristic clinical findings. He was treated with nicotinamide and vitamin B complex, and most of symptoms improved much. Authors reported the case and reviewed the literatures.
Alcoholics ; Diagnosis ; Ear ; Forearm ; Humans ; Hyperpigmentation ; Male ; Middle Aged ; Neck ; Neurologic Manifestations ; Niacinamide ; Pellagra* ; Skin ; Vitamin B Complex

Clinical and postmortem findings of a case that had combined alcoholic pellagra encephalopathy and Wernicke disease are described. This 51-year-old malnourished and chronic alcoholic man presented with progressive mental deterioration, pellagra dermatitis, hypertonus of the neck and other musculatures, myoclonic jerks with bizarre involuntary movements, in addition to total external ophthalmoplegia and gait disturbance. After administration of multivitamins, including thiamine and nicotinamide, these neurologic abnormalities were dramatically improved in a few days. However, the patient died thereafter because of sepsis associated with pneumonia. Postmortem examination revealed marked abnormalities in CNS, characterized by diffuse atrophy of gray matter and widespread neuronal degeneration and characteristic central chromatolysis in pontine nuclei, dentate nuclei, cranial nerve nuclei in the brain stem, Betz cells of the cerebral cortex, and Clarke's column and anterior horn cells of the spinal cord. There were also atrophy and gliosis of the mammillary bodies, degeneration and vascular proliferation of periaqueductal gray matter, and massive gliosis around the third ventricle. These neuropathological changes were compatible with symptoms of both alcoholic pellagra encephalopathy and Wernicke's disease, but they were also strongly suspected on clinical grounds.
Alcoholism/*complications ; Central Nervous System Diseases/complications/pathology ; Humans ; Male ; Middle Aged ; Pellagra/*complications/pathology ; Wernicke Encephalopathy/*complications/pathology

Authors analyzed clinical and electrophysiological features of 35 patients with alcoholic neuropathy who had visited the Boramae City Hospital. All patients were men. Most of the cases drank alcohol everyday. The duration of alcohol consumption is from 2 to 47 years (mean, 17.8 years). Patients with relatively short history of alcohol consumption had a tendency to take more inadequate meals. Clinically we found two distinct separable categories ; one was sensorimotor peripheral neuropathy associated with other alcoholic complications, such as Wemicke and Pellagra disease, delirium tremens, liver disease etc(24 patients). The other had subacutely progressing prominent weakness with sensory change, especially in lower extremities(ll patients). Electrophysiological studies showed decreased amplitudes of sensory or motor compound action potentials with relative preservation of conduction velocity favoring axonal neuropathy. Among the electrophysiological parameters, abnormalities in F-wave(78.3%), H-reflex(86.4%) and sural nerve conduction studies(78.8%) were more frequently observed than in others, which were thought to be more sensitive parameters with early involvement. In terms of electrophysiological pattern there were no definite diffemeces between the two groups.
Action Potentials ; Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholic Neuropathy* ; Alcoholics* ; Axons ; Hospitals, Urban ; Humans ; Liver Diseases ; Male ; Meals ; Pellagra ; Peripheral Nervous System Diseases ; Sural Nerve

Nerve conduction studies and sural nerve biopsies were performed on 13 patients with alcoholic peripheral neuropathy. Most patients had sensory loss and tingling sensation below knees. Wernicke's encephalopathy and pellagra dermatitis were commonly associated. There was no evidence of demyelinating newcpathy in nerve conductoion studies. Myelinated fiber oounts showed loss of small and largetbers in all patients, retaining a bimodal distribution. Segmental denyelination was not found in all teased fibers. Electron microscopy confirmed axonal degeneration of myelinated andunmyelinated fibers with seconday myelin change.
Alcoholics* ; Axons ; Biopsy ; Dermatitis ; Humans ; Knee ; Microscopy, Electron ; Myelin Sheath ; Neural Conduction ; Pellagra ; Peripheral Nervous System Diseases* ; Sensation ; Sural Nerve ; Wernicke Encephalopathy

We analyzed 26 cases of probable alcoholic pellagra encephalopathy (APE) in the chronic heavy alcoholics, associated in 18 cases (69%( with Wernicke's disease and in 15 cases (58%) with alcoholic peripheral neuropathy. They were all males and their average age was 46 years. Daily average amount of drinking was 220gm and average period of drinking was 21.8 years. Clinical manifestations were dermatitis in 23 cases (88%), dementia in 22 (85%) and diarrhea in 12 (46%), but only 7 case (27%) had full triad. Most striking features of the APE were fluctuating confusion and/or clouding of consciousness, marked oppositional hypertonus, myoclonic jerks, severe muscle guarding or tenderness in the abdomen and long-lasting (2 weeks or more) delirious behavior. Twelve patients died of sepsis or pneumonia (3 untreated, 9 of 23 treated with nicotinamide). In conclusion, APE seems to be a fatal disease if untreated. Therefore, even in absence of dermatitis or diarrhea, APE should be considered in heavy chronic alcoholics who develop the deterioration of mentality, associated with above-mentioned clinical features, and they should be treated with multivitamins including nicotinamide.
Abdomen ; Alcoholics* ; Consciousness ; Dementia ; Dermatitis ; Diarrhea ; Drinking ; Hominidae ; Humans ; Male ; Myoclonus ; Niacinamide ; Pellagra* ; Peripheral Nervous System Diseases ; Pneumonia ; Sepsis ; Strikes, Employee ; Wernicke Encephalopathy