Pellagra Post-Roux-en-Y Gastric Bypass Surgery

Area of Science:

• Endocrinology
• Nutritional Science
• Gastroenterology

Background:

• Bariatric surgery, particularly Roux-en-Y gastric bypass, can alter nutrient absorption.
• Alcohol use disorder is a known risk factor for various nutritional deficiencies.
• Pellagra, a niacin deficiency disorder, is infrequently observed post-bariatric surgery.

Observation:

• A 51-year-old woman with a history of Roux-en-Y gastric bypass and breast cancer developed alcohol use disorder.
• She presented with subacute decline in physical and cognitive function, rash, lower extremity pain, anemia, and hypokalemia.
• Niacin levels were undetectable, and initial oral replacement was ineffective.

Findings:

• The patient's symptoms and biochemical derangements resolved with alcohol cessation and parenteral B complex replacement.
• This case highlights the potential for severe niacin deficiency in patients with both bariatric surgery and alcoholism.
• Parenteral niacin administration was necessary due to poor response to oral therapy.

Implications:

• Niacin deficiency should be considered in patients with a history of bariatric surgery and alcohol use disorder presenting with relevant symptoms.
• Screening for alcohol use and niacin levels can aid in early diagnosis and management.
• Parenteral nutrient replacement may be essential in complex cases to prevent severe complications.