Pellagra, 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 deficiency of B vitamins. Although pellagra is 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’s encephalopathy and alcohol withdrawal were suspected. The patient was treated with multivitamins that did not contain nicotinamide and oral diazepam. Despite medical treatment, his cognitive impairment progressively worsened, and pellagra was eventually suspected. His response to nicotinamide treatment was substantial, and he was discharged with no long-term sequelae.
Despite treatable dementia and psychosis, pellagra is often underdiagnosed, especially in developed countries and in alcoholics. Pellagra should be routinely suspected in alcoholic patients because the response to appropriate treatment is usually dramatic.
Found at Alkohol adé (german)