Electrocardiographic enigma of a classical disease: pellagra

Pellagra is caused by a deficiency of niacin. It is endemic in Africa and Asia where the staple diet of the many refugees or displaced people is corn-based and, therefore, nicotinic acid-deficient. It is also frequently seen in developed countries among chronic alcoholics or, occasionally, those suffering from anorexia nervosa. The usual manifestations are diarrhoea, dementia and dermatitis (the 3Ds), which if left untreated may lead to death. Cardiac manifestations and electrocardiographic changes are rarely seen in those suffering from pellagra. We present a case of pellagra in an alcoholic who presented with the classical rash over the upper limbs along with electrocardiographic changes but without any cardiac symptoms, both of which resolved dramatically after he had been given niacin supplements.