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Pupillometry to Assess Auditory Sensation in Guinea Pigs

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Hoarseness in pellagra.

Akiyuki Hiraga¹, Ikuo Kamitsukasa, Nobuyuki Araki

¹Department of Neurology, Chiba Rosai Hospital, Ichihara-shi, Chiba 290-0003, Japan. hiragaa@yahoo.co.jp

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia

|April 22, 2011

Summary

This case study highlights pellagra, a niacin deficiency disease, presenting with unusual laryngitis and hoarseness. Early recognition of these symptoms is crucial for prompt diagnosis and treatment of this uncommon presentation of pellagra.

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Area of Science:

Nutritional Neuroscience
Internal Medicine
Neurology

Background:

Chronic alcoholism is a significant risk factor for multiple vitamin deficiencies.
Thiamine deficiency (beriberi) and niacin deficiency (pellagra) can present with overlapping neurological and mucocutaneous symptoms.

Observation:

A 67-year-old woman with alcoholism presented with progressive weakness, glossitis, and laryngitis.
Initial treatment for suspected thiamine deficiency improved weakness but not glossitis or laryngitis, with subsequent psychosis development.

Findings:

Diagnosis of pellagra was confirmed by decreased serum niacin and thiamine levels.
Laryngitis and psychosis responded dramatically to nicotinamide (niacin) administration, suggesting pellagra as the cause.
Laryngitis and hoarseness are rare manifestations of pellagra, unlike more common stomatitis and glossitis.

Implications:

Hoarseness due to laryngitis can be a predominant and misleading symptom in pellagra.
Clinicians should maintain a high index of suspicion for pellagra in patients with alcoholism and unexplained mucocutaneous or neurological symptoms, including laryngeal involvement.
Understanding vitamin turnover rates may explain the rarity of laryngeal involvement in pellagra.