Encephalopathy pellagra

At present, pellagra is encountered most often in patients with chronic alcoholism, often referred to as alcoholic pellagra encephalopathy (APE). APE patients often show only disturbances of consciousness, but may also manifest myoclonus and ataxia. Administration of niacin is recommended in APE patients showing myoclonus and ataxia even without the classical symptoms found in endemic pellagra patients (Sakai et al., 2006). 

Sakai K, Nakajima T, Fukuhara N (2006) A suspected of alcoholic pellagra encephalopathy with marked response to niacin showing myoclonus and ataxia as chief complaints. No To Shinkei 58(2) 141-144... 

Pellagra-associated encephalopathy has been suspected as an adverse effect of isoniazid administration in several patients with tuberculosis. Deficiency of niacin (nicotinic acid) is characterized by dermatitis, diarrhea, and dementia. Other symptoms can occur, such as seizures, hallucinations, spasticity, and glossitis. Pellagra induced by isoniazid is promoted by malnutrition or a vegetarian diet with low intake of the nicotinamide precursors tryptophan and nicotinic acid. Specific supplementation is essential (10). 

Ishii N, Nishihara Y. Pellagra encephalopathy among tuberculous patients its relation to isoniazid therapy. J Neurol Neurosurg Psychiatry 1985 48(7) 628-34. 

Thiamine, a water-soluble vitamin, is indicated in beriberi, anemia secondary to thiamine deficiency, polyneuritis secondary to alcoholism, pregnancy or pellagra, Wernicke s encephalopathy, and wet beri-beri with myocardial failure. 

Swash M, Roberts AH, Mumaghan DJ. Reversible pellagra-like encephalopathy with ethiona-mide and cycloserine. Tubercle (1972) 53,132-6. 

Niacin deficiency leads to unwanted multisystemic problems that are often associated with dermatological changes. Pellagra is a condition in which niacin deficiency causes a symmetrical pigmented rash, thickened skin and superficial scaling which are found in sun-exposed body areas. The classic triad of niacin deficiency are the three D s—dermatitis, diarrhoea and dementia (Hegyi et al. 2004). Some of the effects on the central nervous system include depression, anxiety, restlessness and poor concentration. In addition, alcoholic individuals with poor nutrition can develop pellagroid encephalopathy (Cook et al. 1998). The role of niadn deficiency in cardiovascular disease and lipid metabolism remains to be fully explored. 

Psychiatric manifestations are fairly common but are easily overlooked due to their non-specific nature. These are commonly seen as irritability, poor concentration, anxiety, fatigue, restlessness, apathy and depression. The occurrence of psychosis in pellagra is an uncommon finding, especially as an early feature and we have described it under a separate heading. Additionally, the psychotic spectrum is usually seen in advanced stages of pellagroid encephalopathy, commonly found in chronic alcoholics (Cook et al. 1998). 

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