1
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Yogi TN, B.C. P, Bhusal A, Limbu S, Kafle R. Alcoholic pellagrous encephalopathy: a case report on atypical presentation and diagnostic dilemma in alcohol-related disorders. Ann Med Surg (Lond) 2024; 86:501-506. [PMID: 38222748 PMCID: PMC10783386 DOI: 10.1097/ms9.0000000000001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/01/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological presentation of pellagra in a long-term alcohol and substance abuser, emphasizing the diagnostic challenges in resource-constrained settings. Case presentation A 36-year-old male with a history of substance abuse presented with multiple symptoms, including hallucinations and neurological deficits. His complex clinical history included alcohol dependence, seizures, and relapses. Physical and neurological examinations revealed characteristic signs of pellagrous encephalopathy. Laboratory findings confirmed anemia and a fatty liver. Discussion Alcoholic pellagrous encephalopathy (APE) presents a diagnostic challenge due to its atypical symptoms, overlapping with other alcohol-related disorders. Niacin deficiency, central to its pathogenesis, affects neurotransmitter synthesis, contributing to neurological symptoms. Diagnosis relies on clinical presentation, but laboratory tests for niacin levels can aid in confirmation. Neuroimaging can exclude alternative causes. This case underscores the importance of considering pellagrous encephalopathy in alcohol-related disorders with neurological symptoms. Conclusion This case underscores the importance of recognizing atypical presentations of APE in chronic alcohol-dependent individuals. Prompt diagnosis, nutritional correction, and addressing alcohol use are vital for successful management. Healthcare providers must be aware of the diagnostic complexities and socioeconomic barriers hindering timely intervention in APE.
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Affiliation(s)
| | - Pooja B.C.
- Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
| | - Amrit Bhusal
- Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
| | - Suren Limbu
- Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
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2
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Lahoti A, Singh A, Bisen YT, Bakshi AM. Cutaneous Manifestations and Neurological Diseases. Cureus 2023; 15:e47024. [PMID: 37965391 PMCID: PMC10642374 DOI: 10.7759/cureus.47024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Our skin and nervous system are tightly connected. Numerous dermatomes on our skin provide sensory information to the brain. Because skin changes can occasionally be the first sign of a neurological problem, understanding skin alterations is crucial as it can indicate early about the underlying condition, which can affect the prognosis of the disease. In these cases, the dermatologists' and neurologists' skills are complementary to each other. In this article, we have categorized diseases with neuro-cutaneous manifestations under different headings, such as infections, metabolic diseases, connective tissue disorders, genodermatoses, nutritional deficiency, and the diagnostic criteria of some commonly encountered diseases. Through tabulation, it has been observed that this categorization can serve as a useful reference for managing day-to-day patients who are either diagnosed with the diseases mentioned above or suspected to have the conditions.
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Affiliation(s)
- Arpita Lahoti
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Adarshlata Singh
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yuganshu T Bisen
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amey M Bakshi
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Forster AM, Zechmann S, Plaza T. [Pellagra-a clinical-dermatohistopathological diagnosis for skin picking disorder]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:535-537. [PMID: 37166459 PMCID: PMC10289913 DOI: 10.1007/s00105-023-05157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Anna-Maria Forster
- Poliklinik für Dermatologie und Venerologie, Universitätsspital Basel, Medizinische Universität Basel, Burgfelderstrasse 101, 4055, Basel, Schweiz.
| | - Stefan Zechmann
- Universitätsklinik für Innere Medizin, Universitätsspital Zürich, Zürich, Schweiz
| | - Tobias Plaza
- Plaza Kliniken, Oberlandstr. 100, 8610, Uster, Schweiz
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4
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Arvon JN, Lemons W, Vijay C, Lynch JD. Diffuse Rash in a 10-year-old Boy with Autism. Pediatr Rev 2023; 44:e20-e23. [PMID: 37391638 DOI: 10.1542/pir.2021-005226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Affiliation(s)
- Jessica N Arvon
- West Virginia University School of Medicine, J.W. Ruby Memorial Hospital, Morgantown, WV
| | - Wesley Lemons
- West Virginia University School of Medicine, J.W. Ruby Memorial Hospital, Morgantown, WV
| | - Chickajajur Vijay
- Division of Pediatric Hospital Medicine, Department of Pediatrics, West Virginia University, J.W. Ruby Memorial Hospital, Morgantown, WV
| | - Joseph D Lynch
- Division of Pediatric Hospital Medicine, Department of Pediatrics, West Virginia University, J.W. Ruby Memorial Hospital, Morgantown, WV
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5
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Narula S, Hajeh H, Radicic K, Mishra S. Pellagra, from history books to present clinical practice: a case report of pellagrous encephalopathy in the setting of alcohol withdrawal. Intern Med J 2023; 53:1290-1291. [PMID: 37474465 DOI: 10.1111/imj.16161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/23/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Sameer Narula
- Ross University School of Medicine, Miramar, Florida, USA
| | - Hajeh Hajeh
- Kern Medical, Department of Medicine, Bakersfield, California, USA
| | - Kasey Radicic
- Kern Medical, Department of Medicine, Bakersfield, California, USA
| | - Shikha Mishra
- Kern Medical, Department of Medicine, Bakersfield, California, USA
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6
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Boileau M, Azib S, Staumont-Sallé D, Dezoteux F. Increased risk of pellagra in an alcoholic patient treated with antiepileptic drugs. Ann Dermatol Venereol 2022; 149:284-285. [PMID: 35623939 DOI: 10.1016/j.annder.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 12/30/2022]
Affiliation(s)
- M Boileau
- Service de Dermatologie, Centre Hospitalier Universitaire de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France.
| | - S Azib
- Service de Dermatologie, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - D Staumont-Sallé
- Service de Dermatologie, Centre Hospitalier Universitaire de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France
| | - F Dezoteux
- Service de Dermatologie, Centre Hospitalier Universitaire de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France
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7
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Wijdicks EFM. Identifying encephalopathies from acute metabolic derangements. J Intern Med 2022; 292:846-857. [PMID: 35809045 DOI: 10.1111/joim.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Metabolic derangements, when acute and severe, affect brain function. This presents mostly with a marked decline in the level of consciousness, resulting in impaired responsiveness, abnormal receptivity, impaired content, and loss of memory retention. The term metabolic encephalopathy has been used but is conjecture that can be challenged in the age of modern neuroimaging. We now recognize that many metabolic encephalopathies may involve structural lesions and at an early stage. Common clinical conundrums are the evaluation of the degree of brain injury and its recoverability. This review discusses the appropriate terminology for these conditions, the diagnostic approach, therapy recommendations, and prediction of recovery potential. In evaluating a presumed metabolic cause for encephalopathy, we must (1) search for and rule out structural injury to the brain despite an obvious explanatory metabolic derangement, (2) recognize that several confounding conditions often co-exist, and (3) acknowledge that resolution of brain dysfunction may be protracted despite normalization of laboratory values.
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Affiliation(s)
- Eelco F M Wijdicks
- Division of Neurocritical Care and Hospital Neurology, Mayo Clinic, Rochester, Minnesota, USA
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8
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Tew JC, Harrington L, Elsayed H, Mlawa G. Pellagra as a differential diagnosis in the confused patient on the acute medical unit. BMJ Case Rep 2022; 15:e249405. [PMID: 36323450 PMCID: PMC9639017 DOI: 10.1136/bcr-2022-249405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A man in his 80s was admitted via the acute medical take after presenting with increased confusion and features of alcohol withdrawal. He had a several-month history of a worsening pruritic rash surrounding his neck, arms and legs in addition to new, profuse diarrhoea. In view of the background of known chronic alcoholism and the coexisting symptoms of rash, confusion and diarrhoea, pellagra was diagnosed via a multidisciplinary approach. Oral nicotinamide supplementation was commenced and his symptoms responded rapidly. The bias and challenge of reaching a unified diagnosis in the context of a multisystem condition are exemplified in this case report.
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Affiliation(s)
- Jennifer Catherine Tew
- Acute Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Laura Harrington
- General Internal Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Haythum Elsayed
- General Internal Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Gideon Mlawa
- Diabetes and Endocrinology/General Internal Medicine, Queen's Hospital Romford, London, UK
- Diabetes and Endocrinology/General Internal Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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9
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López-Alba A, Corbella L, Gallego-Gutierrez I. Pellagra Gloves. Mayo Clin Proc 2022; 97:445-446. [PMID: 35246285 DOI: 10.1016/j.mayocp.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
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10
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Rapidly progressive dementia and intractable diarrhea: a teaching case report and a systematic review of cognitive impairment in Whipple’s disease. Neurol Sci 2022; 43:907-926. [PMID: 34981284 PMCID: PMC8722651 DOI: 10.1007/s10072-021-05844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022]
Abstract
Objective Methods Results Conclusions Supplementary Information
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11
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Mills K, Akintayo O, Egbosiuba L, Dadzie S, Skyles A, Jang K, Fatima S, Fas N. Chronic Diarrhea in a Drinker: A Breakthrough Case of Pellagra in the US South. J Investig Med High Impact Case Rep 2020; 8:2324709620941305. [PMID: 32646238 PMCID: PMC7357129 DOI: 10.1177/2324709620941305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The triad of diarrhea, dementia, and dermatitis constitutes the clinical diagnosis of pellagra. However, most reported cases of pellagra have occurred without all components of the triad. Pellagra was declared eradicated in the United States after an outbreak in the 1920s, and is now considered to be an exceedingly rare diagnosis in developed countries. In this article, we present a case of a 56-year-old man who presented with a significant history of alcohol use and chronic diarrhea. Pellagra was clinically diagnosed based on the triad of diarrhea, cognitive dysfunction, and dermatitis in this malnourished, alcoholic patient. The patient was treated and clinically improved with resolution of his diarrhea and cognitive dysfunction.
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Affiliation(s)
| | | | | | | | | | - Kudo Jang
- Morehouse School of Medicine, Atlanta, GA, USA
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12
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Braidy N, Villalva MD, van Eeden S. Sobriety and Satiety: Is NAD+ the Answer? Antioxidants (Basel) 2020; 9:antiox9050425. [PMID: 32423100 PMCID: PMC7278809 DOI: 10.3390/antiox9050425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Nicotinamide adenine dinucleotide (NAD+) is an essential pyridine nucleotide that has garnered considerable interest in the last century due to its critical role in cellular processes associated with energy production, cellular protection against stress and longevity. Research in NAD+ has been reinvigorated by recent findings that components of NAD+ metabolism and NAD-dependent enzymes can influence major signalling processes associated with the neurobiology of addiction. These studies implicate raising intracellular NAD+ levels as a potential target for managing and treating addictive behaviour and reducing cravings and withdrawal symptoms in patients with food addiction and/or substance abuse. Since clinical studies showing the use of NAD+ for the treatment of addiction are limited, this review provides literature evidence that NAD+ can influence the neurobiology of addiction and may have benefits as an anti-addiction intervention.
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Affiliation(s)
- Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia;
- Correspondence:
| | - Maria D. Villalva
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Sam van Eeden
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK;
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13
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Fuller-Thomson E, Mehta R. Could a gene-environment interaction between NAPRT1 risk allele and pre-natal niacin deficiency explain 4 medical mysteries of schizophrenia research? Schizophr Res 2020; 216:532-533. [PMID: 31839551 DOI: 10.1016/j.schres.2019.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work & Faculty of Medicine, University of Toronto, Canada; Institute for Life Course & Aging, University of Toronto, Canada.
| | - Rukshan Mehta
- Doctoral Program in Nutrition & Health Sciences, Rollins School of Public Health, Emory University, United States of America
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14
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Tardy AL, Pouteau E, Marquez D, Yilmaz C, Scholey A. Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients 2020; 12:E228. [PMID: 31963141 PMCID: PMC7019700 DOI: 10.3390/nu12010228] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 12/17/2022] Open
Abstract
Vitamins and minerals are essential to humans as they play essential roles in a variety of basic metabolic pathways that support fundamental cellular functions. In particular, their involvement in energy-yielding metabolism, DNA synthesis, oxygen transport, and neuronal functions makes them critical for brain and muscular function. These, in turn, translate into effects on cognitive and psychological processes, including mental and physical fatigue. This review is focused on B vitamins (B1, B2, B3, B5, B6, B8, B9 and B12), vitamin C, iron, magnesium and zinc, which have recognized roles in these outcomes. It summarizes the biochemical bases and actions of these micronutrients at both the molecular and cellular levels and connects them with cognitive and psychological symptoms, as well as manifestations of fatigue that may occur when status or supplies of these micronutrients are not adequate.
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Affiliation(s)
- Anne-Laure Tardy
- Sanofi Consumer Healthcare, Global Medical Nutritionals, 94250 Gentilly, France;
| | - Etienne Pouteau
- Sanofi Consumer Healthcare, Global Medical Nutritionals, 94250 Gentilly, France;
| | | | - Cansu Yilmaz
- Sanofi Consumer Healthcare, 34394 Beşiktaş Istanbul, Turkey;
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Victoria, VIC 3122, Australia;
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15
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Cao S, Wang X, Cestodio K. Pellagra, an Almost-Forgotten Differential Diagnosis of Chronic Diarrhea: More Prevalent Than We Think. Nutr Clin Pract 2019; 35:860-863. [PMID: 31599018 DOI: 10.1002/ncp.10418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pellagra, caused by vitamin B3 (niacin) deficiency, is traditionally described as dermatitis, diarrhea, dementia (3D), and even death (4D) syndrome if not recognized and treated promptly. Although full-blown pellagra with all 3D features has become rare, pellagra still exists, especially in high-risk populations, which is actually more prevalent than we think. We report that a recently treated patient with the full spectrum of 3D clinical features of pellagra presents as chronic diarrhea of unknown etiology for 1 year. It reminds us that keeping a high index of suspicion and maintaining a broad differential diagnosis are critical for recognition and management of this potentially fatal but treatable condition.
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Affiliation(s)
- Shanjin Cao
- Department of Hospitalist, Charlton Memorial Hospital, Fall River, MA, USA.,Department of Hospitalist, Prima CARE, P.C., Fall River, MA, USA
| | - Xiaodan Wang
- Department of Hospitalist, Charlton Memorial Hospital, Fall River, MA, USA.,Department of Hospitalist, Prima CARE, P.C., Fall River, MA, USA
| | - Kristen Cestodio
- Department of Hospitalist, Charlton Memorial Hospital, Fall River, MA, USA.,Department of Hospitalist, Prima CARE, P.C., Fall River, MA, USA
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16
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Luthe SK, Sato R. Alcoholic Pellagra as a Cause of Altered Mental Status in the Emergency Department. J Emerg Med 2017; 53:554-557. [PMID: 28736097 DOI: 10.1016/j.jemermed.2017.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/10/2017] [Accepted: 05/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pellagra, which is caused by a deficiency of niacin and tryptophan, the precursor of niacin, is a rare disease in developed countries where alcoholism is a major risk factor due to malnutrition and lack of B vitamins. Although pellagra involves treatable dementia and psychosis, it is often underdiagnosed, especially in developed countries. CASE REPORT In Japan, a 37-year-old man presented to the emergency department with altered mental status and seizures. Wernicke encephalopathy and alcohol withdrawal were suspected. The patient was treated with multivitamins, which did not include nicotinic acid amide, and oral diazepam. Despite medical treatment, his cognitive impairment progressively worsened, and eventually, pellagra was suspected. His response to treatment with nicotinic acid amide was substantial, and he was discharged without any long-term sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite the treatable dementia and psychosis, pellagra is often underdiagnosed, especially in developed countries and alcoholic patients. Pellagra should be routinely suspected in alcoholic patients because the response to appropriate treatment is typically dramatic.
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Affiliation(s)
| | - Ryota Sato
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
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17
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Li R, Yu K, Wang Q, Wang L, Mao J, Qian J. Pellagra Secondary to Medication and Alcoholism: A Case Report and Review of the Literature. Nutr Clin Pract 2016; 31:785-789. [PMID: 27491713 DOI: 10.1177/0884533616660991] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pellagra usually results from niacin deficiency and presents with the classic triad of dermatitis, diarrhea, and dementia. It is most commonly associated with malnutrition and poverty and is extremely rare in industrialized societies. Furthermore, pellagra can be induced by special clinical conditions that interfere with the intake, absorption, and metabolism of niacin. Because of its detrimental effects on health and its favorable prognosis after supplementation of nicotinamide, the importance of early diagnosis and treatment should be emphasized. Herein, we report a case of pellagra in a young alcoholic who underwent combined chemotherapy for tuberculosis. For the first time, a descriptive review of literature from 1957 to 2014 has been conducted to clarify potential etiologies of pellagra: alcoholism (35.24%, 37 articles), various medications (25.71%, 27 articles), inadequate oral intake (16.19%, 17 articles), malabsorption (13.33%, 14 articles), metabolic derangement (7.62%, 8 articles), excessive loss (0.95%, 1 article), and etiology unknown (0.95%, 1 article).
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Affiliation(s)
- Rongrong Li
- 1 Department of Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- 1 Department of Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Wang
- 2 Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lilin Wang
- 3 Department of Cardiology, First People's Hospital of Yunnan Providence, Kunming, China
| | - Jiangfeng Mao
- 4 Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaming Qian
- 2 Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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19
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Sechi G, Sechi E, Fois C, Kumar N. Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev 2016; 74:281-300. [PMID: 27034475 DOI: 10.1093/nutrit/nuv107] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
B vitamin deficiency is a leading cause of neurological impairment and disability throughout the world. Multiple B vitamin deficiencies often coexist, and thus an understanding of the complex relationships between the different biochemical pathways regulated in the brain by these vitamins may facilitate prompter diagnosis and improved treatment. Particular populations at risk for multiple B vitamin deficiencies include the elderly, people with alcoholism, patients with heart failure, patients with recent obesity surgery, and vegetarians/vegans. Recently, new clinical settings that predispose individuals to B vitamin deficiency have been highlighted. Moreover, other data indicate a possible pathogenetic role of subclinical chronic B vitamin deficiency in neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. In light of these findings, this review examines the clinical manifestations of B vitamin deficiency and the effect of B vitamin deficiency on the adult nervous system. The interrelationships of multiple B vitamin deficiencies are emphasized, along with the clinical phenotypes related to B vitamin deficiencies. Recent advances in the clinical determinants and diagnostic clues of B vitamin deficiency, as well as the suggested therapies for B vitamin disorders, are described.
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Affiliation(s)
- GianPietro Sechi
- G.P. Sechi, E. Sechi, and C. Fois are with the Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. N. Kumar is with the Mayo Clinic, Rochester, Minnesota, USA.
| | - Elia Sechi
- G.P. Sechi, E. Sechi, and C. Fois are with the Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. N. Kumar is with the Mayo Clinic, Rochester, Minnesota, USA
| | - Chiara Fois
- G.P. Sechi, E. Sechi, and C. Fois are with the Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. N. Kumar is with the Mayo Clinic, Rochester, Minnesota, USA
| | - Neeraj Kumar
- G.P. Sechi, E. Sechi, and C. Fois are with the Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. N. Kumar is with the Mayo Clinic, Rochester, Minnesota, USA
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20
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Park K, Oeda T, Sawada H. A case of alcoholic pellagra encephalopathy presenting with spinal myoclonus. Neurol Clin Pract 2015; 5:472-474. [PMID: 29595842 DOI: 10.1212/cpj.0000000000000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kwiyoung Park
- Department of Neurology and Clinical Research Center, Utano National Hospital, Kyoto, Japan
| | - Tomoko Oeda
- Department of Neurology and Clinical Research Center, Utano National Hospital, Kyoto, Japan
| | - Hideyuki Sawada
- Department of Neurology and Clinical Research Center, Utano National Hospital, Kyoto, Japan
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21
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Sinthupoom N, Prachayasittikul V, Prachayasittikul S, Ruchirawat S, Prachayasittikul V. Nicotinic acid and derivatives as multifunctional pharmacophores for medical applications. Eur Food Res Technol 2014. [DOI: 10.1007/s00217-014-2354-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Thornton AM, Drummond CJ. An unexpected case of pellagra. Med J Aust 2014; 200:546-8. [PMID: 24835720 DOI: 10.5694/mja13.11187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/17/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Alicia M Thornton
- Department of Dermatology, Canberra Hospital, Canberra, ACT, Australia.
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23
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Crook MA. The importance of recognizing pellagra (niacin deficiency) as it still occurs. Nutrition 2014; 30:729-30. [DOI: 10.1016/j.nut.2014.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Abstract
We report a case of a 50-year old homeless male who presented with pellagra and pellagrous encephalopathy. The characteristic - if not pathognomonic - skin lesions of pellagra support its diagnosis on solely clinical grounds. Clinicians should keep a high index of suspicion, in certain patient groups, in order to early diagnose and cure this potentially fatal but treatable disease.
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Affiliation(s)
- Savvoula Savvidou
- 1 Department of Internal Medicine, Papageorgiou University Hospital of Thessaloniki , Thessaloniki, Greece
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25
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Abstract
Historical and clinical aspects of pellagra and its relationship to alcoholism are reviewed from a biochemical perspective. Pellagra is caused by deficiency of niacin (nicotinic acid) and/or its tryptophan (Trp) precursor and is compounded by B vitamin deficiencies. Existence on maize or sorghum diets and loss of or failure to isolate niacin from them led to pellagra incidence in India, South Africa, Southern Europe in the 18th century and the USA following the civil war. Pellagra is also induced by drugs inhibiting the conversion of Trp to niacin and by conditions of gastrointestinal dysfunction. Skin photosensitivity in pellagra may be due to decreased synthesis of the Trp metabolite picolinic acid → zinc deficiency → decreased skin levels of the histidine metabolite urocanic acid and possibly also increased levels of the haem precursor 5-aminolaevulinic acid (5-ALA) and photo-reactive porphyrins. Depression in pellagra may be due to a serotonin deficiency caused by decreased Trp availability to the brain. Anxiety and other neurological disturbances may be caused by 5-ALA and the Trp metabolite kynurenic acid. Pellagra symptoms are resolved by niacin, but aggravated mainly by vitamin B6. Alcohol dependence can induce or aggravate pellagra by inducing malnutrition, gastrointestinal disturbances and B vitamin deficiencies, inhibiting the conversion of Trp to niacin and promoting the accumulation of 5-ALA and porphyrins. Alcoholic pellagra encephalopathy should be managed with niacin, other B vitamins and adequate protein nutrition. Future studies should explore the potential role of 5-ALA and also KA in the skin and neurological disturbances in pellagra.
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26
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Abstract
PURPOSE OF REVIEW This study will review the biologic roles of thiamine, niacin, folic acid, cobalamin, antioxidants, lipids, glucose, and water and their implications as contributors or causal agents in the development of delirium, particularly if deficiencies or excesses exist. RECENT FINDINGS Knowledge on how overall nutritional status and individual nutrients predispose or directly lead to the development of delirium is currently very limited. Most studies in the area of nutrition and cognition still describe mental status changes using the term dementia and do not specifically address nutrition and delirium. However, as the brain pathophysiology that accompanies delirium has been furthered elucidated, it has become clear that nutritional imbalances can lead to these same physiologic changes in neuronal tissue. SUMMARY Delirium, characterized by an acute change in mental status along with diminished awareness and attention and disturbances in memory, language, or perception, confers high rates of morbidity and mortality and can be difficult to both diagnose and treat. Although the cause of delirium is often multifactorial, nutritional status and nutrients may play a role in predisposing or directly causing this acute cognitive dysfunction. Many nutritional deficiencies or excesses (i.e., B vitamins, antioxidants, glucose, water, lipids) have been shown to alter the way one thinks and restoring the balance in many of these nutrients can lead to resolution of delirium.
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Affiliation(s)
- Angela M Sanford
- Department of Internal Medicine, Division of Geriatrics, Saint Louis University School of Medicine, St Louis, Missouri, USA
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