Pellagra and alcoholism: case report
Main Article Content
Abstract
Pellagra is mainly caused by a niacin deficiency or its precursor amino acid, tryptophan. We report a case of a male patient, 34 years old, a chronic alcoholic with delirium tremens and gastrointestinal symptoms (diarrhea, inappetence, and heartburn). He presented erythematous-brown, scaly, and well-defined plaques dispersed throughout the integument (photo-exposed areas) for 2 months that evolved with ulceration and hematic crusts. The case was diagnosed as pellagra associated with secondary bacterial infection and treated with rest, an unrestricted diet, B-complex replacement, abstention from alcohol, restriction of sun exposure, and broad-spectrum antibiotic therapy. The treatment allowed for significant improvement of symptoms in one week. Aspects of the pathophysiology and differential diagnoses of this condition are discussed, reinforcing the importance of considering pellagra in diagnosing patients with skin lesions associated with risk factors for malnutrition.
Article Details
Authors maintain copyright and grant the HSJ the right to first publication. From 2024, the publications wiil be licensed under Attribution 4.0 International , allowing their sharing, recognizing the authorship and initial publication in this journal.
Authors are authorized to assume additional contracts separately for the non-exclusive distribution of the version of the work published in this journal (e.g., publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
Authors are encouraged to publish and distribute their work online (e.g., in institutional repositories or on their personal page) at any point after the editorial process.
Also, the AUTHOR is informed and consents that the HSJ can incorporate his article into existing or future scientific databases and indexers, under the conditions defined by the latter at all times, which will involve, at least, the possibility that the holders of these databases can perform the following actions on the article.
References
Rivitti EA. Manual de dermatologia clínica de Sampaio e Rivitti. São Paulo: Artes Médicas; 2014. p. 448-449.
Badawy AA. Pellagra and Alcoholism: A Biochemical Perspective. Alcohol and Alcoholism. 2014;49(3):238-50. https://doi.org/10.1093/alcalc/agu010 DOI: https://doi.org/10.1093/alcalc/agu010
Prabhu D, Dawe RS, Mponda K. Pellagra a review exploring causes and mechanisms, including isoniazid-induced pellagra. Photodermatol Photoimmunol Photomed. 2021;37(2):99-104. https://doi.org/10.1111/phpp.12659 DOI: https://doi.org/10.1111/phpp.12659
Morabia A. Joseph Goldberger's research on the prevention of pellagra. J R Soc Med. 2008;101(11):566-8. https://doi.org/10.1258/jrsm.2008.08k010 DOI: https://doi.org/10.1258/jrsm.2008.08k010
López M, Olivares JM, Berrios GE. Pellagra encephalopathy in the context of alcoholism: review and case report. Alcohol Alcohol. 2013;49(1):38-41. https://doi.org/10.1093/alcalc/agt070 DOI: https://doi.org/10.1093/alcalc/agt070
Gupta Y, Shah I. Ethionamide-induced Pellagra. J Trop Pediatr. 2015; 61(4):301-3. https://doi.org/10.1093/tropej/fmv021 DOI: https://doi.org/10.1093/tropej/fmv021
Piqué-Duran E, Pérez-Cejudo JA, Cameselle D, Palacios-Llopis S, García-Vázquez O. Pellagra: a clinical, histopathological, and epidemiological study of 7 cases. Actas Dermosifiliogr. 2012;103(1):51-8. https://doi.org/10.1016/j.adengl.2011.05.003 DOI: https://doi.org/10.1016/j.adengl.2011.05.003
López D, Otero G. Pelagra: una enfermedad antigua en un mundo moderno. Nutr Hosp. 2021;38(3):667-70. https://doi.org/10.20960/nh.03513 DOI: https://doi.org/10.20960/nh.03513
Ng E, Neff M. Recognising the return of nutritional deficiencies: a modern pellagra puzzle. BMJ Case Rep. 2018;11(1):e227454. https://doi.org/10.1136/bcr-2018-227454 DOI: https://doi.org/10.1136/bcr-2018-227454
Matapandeu G, Dunn SH, Pagels P. An Outbreak of Pellagra in the Kasese Catchment Area, Dowa, Malawi. Am J Trop Med Hyg. 2017;96(5):1244-7. https://doi.org/10.4269/ajtmh.16-0423 DOI: https://doi.org/10.4269/ajtmh.16-0423
Desai NK, Gable BP. Dermatitis as one of the 3 Ds of pellagra. Mayo Clin Proc. 2012;87(12):e113. https://doi.org/10.1016/j.mayocp.2012.08.018 DOI: https://doi.org/10.1016/j.mayocp.2012.08.018
Braverman ER. Medical history and holistic perspective. J Orthomol Med. 1988;3(4):191-6.
Noleto RS, Pinto NS, Godoy JSR. Pelagra: Correlação entre o diagnóstico e a apresentação clínica mais prevalente no Brasil. Res Soc Develop. 2021;10(9):e7210917787. https://doi.org/10.33448/rsd-v10i9.17787 DOI: https://doi.org/10.33448/rsd-v10i9.17787
Murga Y, Parra V, Aredes A, Alasino M, Torres A, Santolín L, et al. Manifestaciones cutáneas en el paciente alcohólico. Relación con la cirrosis. Dermatol Argent [Internet]. 2009 [cited 2022 Sep 3];15(4):255-259. Available from: https://test.dermatolarg.org.ar/index.php/dermatolarg/article/view/385