Pellagra induced psychosis: a rare presentation
DOI:
https://doi.org/10.18203/2320-6012.ijrms20191353Keywords:
Dementia, Neuropsychiatric symptoms, PellagraAbstract
Pellagra is a nutritional deficiency disease associated with low levels of niacin (vitamin B3). Neuropsychiatric symptoms are rare and are difficult to be diagnosed by clinicians in a timely manner. A 35 years old male was brought with complaints of generalized weakness, decreased appetite and work impairment since past 4 years. Scaly and itching skin rashes have also been present since 3 months followed by hearing voices, suspiciousness and agitated behaviour since one month. On examination, he had pruritic skin rashes over hands which extended over face and neck. His diet comprised mainly of jowar and maize and had history of occasional alcohol use. With an initial diagnosis of psychosis, the patient was started on oral olanzapine. Laboratory and imaging investigations were within normal limits. Dermatology referral confirmed pellagra clinically. The patient was started on injectable multivitamins for 14 days and later shifted to oral multivitamins. Patient showed significant improvement in his skin and neuropsychiatric symptoms. Present case suggests that physicians need to remain vigilant because it is easy to overlook such patients. Pellagra has an insidious onset and psychiatric symptoms appear rare and late in the course when disease is allowed to progress.
References
Delgado-Sanchez L, Godkar D, Niranjan S. Pellagra: Rekindling of an Old Flame. Am J Therapeut. 2008;15:173-5.
Cavanna AE, Williams AC. Neuropsychiatric symptoms in an early description of pellagra. J Neuropsychiat Clin Neurosci. 2010;22(4):451-e39.
Brim CJ. Job's illness-pellagra. Arch Dermatol Syphilol. 1942;45(2):371-6.
Bean WB, Spies TD, Blankenhorn MA. Secondary pellagra. Medicine. 1944;23(1):1-78.
Berrios GE. Dementia during the 17th and 18th century: a conceptual history. Psychol Med. 1987;17:829-37.
Serdaru M, Hausser-Hauw CH, Laplane D, Buge A, Castaigne P, Goulon M, et al. The clinical spectrum of alcoholic pellagra encephalopathy: a retrospective analysis of 22 cases studied pathologically. Brain. 1988 Aug 1;111(4):829-42.
Ishii N, Nishihara Y. Pelagra among chronic alcoholics: clin- ical and pathological study of 20 necropsy cases. J Neurol Neurosurg Psychiatry. 1981;44:209-15.
Penkowa M, Giralt M, Camats J, Hidalgo J. Metallothionein 1+ 2 protect the CNS during neuroglial degeneration induced by 6‐aminonicotinamide. J Comparative Neurol. 2002 Mar 5;444(2):174-89.
Messamore E, Hoffman WF, Janowsky A. The niacin skin flush abnormality in schizophrenia: a quantitative dose-response study. Schizophr Res. 2003;62:251-8.
Puri BK, Easton T, Das I, Kidane L, Richardson AJ. The niacin skin flush test in schizophrenia: a replication study. Int J Clin Pract. 2001;55(6):368-70.