JOURNAL OF CLINICAL AND BIOMEDICAL SCIENCES

Article

Journal of Clinical and Biomedical Sciences

Year: 2023, Volume: 13, Issue: 3, Pages: 94-96

Case Report

The Guard, His Gauntlet and Goblet- An Atypical Presentation of Pellagra in a Chronic Alcoholic

Received Date:12 September 2023, Accepted Date:21 September 2023, Published Date:16 October 2023

Abstract

Alcoholism a chronic condition affects multiple organ systems including skin. Dermatological markers of alcohol abuse are invaluable. Despite this, association of skin diseases and alcohol misuse maybe overlooked or physicians fail to explore. Pellagra is a multifactorial disease caused by Niacin/Tryptophan deficiency. It exhibits photodermatitis, gastrointestinal and neuropsychiatric manifestations. Chronic alcoholics are at risk. Considering pellagra as differential diagnosis in chronic alcoholics with these symptoms is crucial. This disease is easily treatable but if missed proves fatal. Hence, its recognition is important in other clinical settings for comprehensive treatment. The pathognomonic presentation of Pellagra is the Casal necklace, but here we present a case of 34year old alcoholic with an atypical presentation of Pellagra. Chronic alcoholics need evaluation for Pellagra amongst other nutritional deficiencies which due to diverse presentation can be missed. Early diagnosis and treatment can avoid impending neuropsychiatric complications. Due to participation of numerous disciplines consultation liaison psychiatry is vital here.

Keywords: Alcohol dependence, Alcohol cutaneous manifestations, Pellagra, Niacin deficiency, Alcohol biomarkers

References

  1. Sengotuven KL, Murugaiyan R, Kaliaperumal K. Cutaneous manifestations of chronic alcoholism: a cross sectional study in a tertiary care centre in South India. International Journal of Research in Dermatology. 2016;2(4):55–63. Available from: https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20163510
  2. Smith B, Curtis A, Parsons A, Yosipovitch G, Sangüeza OP. A 41-Year-Old Woman With a Scaly Erythematous Plaque Admixed With Erosions on the Groin, .,;. The American Journal of Dermatopathology. 2010;32(8):850. Available from: https://journals.lww.com/amjdermatopathology/citation/2010/12000/a_41_year_old_woman_with_a_scaly_erythematous.20.aspx
  3. Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. International journal of dermatology. 2004;43(1):1–5. Available from: https://doi.org/10.1111/j.1365-4632.2004.01959.x
  4. Wan P, Moat S, Anstey A. Pellagra: a review with emphasis on photosensitivity. British Journal of Dermatology. 2011;164(6):1188–1200. Available from: https://doi.org/10.1111/j.1365-2133.2010.10163.x
  5. Chichakli H, Frosch PJ, Brinkmeier T. Symmetrical bullous acral erythema in a 58-year-old female alcoholic. The dermatologist. 2006;57:1030–1034. Available from: https://doi.org/10.1007/s00105-006-1128-5
  6. Higgins EM, Vivier AWPd. Cutaneous disease and alcohol misuse. British medical bulletin. 1994;50(1):85–98. Available from: https://doi.org/10.1093/oxfordjournals.bmb.a072887
  7. Sato M, Matsumura Y, Kojima A, Nakashima C, Katoh M, Kore-Eda S, et al. Pellagra-like erythema on sun-exposed skin of patients with anorexia nervosa. The Journal of Dermatology. 2011;38(10):1037–1040. Available from: https://doi.org/10.1111/j.1346-8138.2010.01164.x
  8. 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 Dermo-Sifiliográficas (English Edition). 2012;103(1):51–58. Available from: https://doi.org/10.1016/j.ad.2011.05.001
  9. Ishii N, Nishihara Y. Pellagra among chronic alcoholics: clinical and pathological study of 20 necropsy cases. Journal of Neurology, Neurosurgery & Psychiatry. 1981;44(3):209–215. Available from: http://dx.doi.org/10.1136/jnnp.44.3.209
  10. Brown TM. Pellagra: An Old Enemy of Timeless Importance. Psychosomatics. 2010;51(2):93–97. Available from: https://doi.org/10.1016/S0033-3182(10)70668-X
  11. Karthikeyan K, Thappa DM. Pellagra and skin. International journal of dermatology. 2002;41:476–481. Available from: https://doi.org/10.1046/j.1365-4362.2002.01551.x

Copyright

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Published By Sri Devaraj Urs Academy of Higher Education, Kolar, Karnataka

DON'T MISS OUT!

Subscribe now for latest articles and news.