Pellagra: An Unusual Cause for Altered Mental Status

Area of Science:

• Nutritional Science
• Internal Medicine
• Clinical Case Study

Background:

• Pellagra, a disease resulting from niacin (vitamin B3) deficiency, is characterized by dermatitis, diarrhea, and dementia.
• Historically prevalent, pellagra was thought to be eradicated in the U.S. due to food fortification.
• Concerns exist regarding its resurgence in specific populations, including those with chronic alcoholism, malabsorption syndromes, and anorexia nervosa.

Observation:

• A patient presented with altered mental status during hospitalization.
• The patient subsequently developed diarrhea, prompting further investigation.
• A comprehensive workup led to the diagnosis of pellagra.

Findings:

• The patient was diagnosed with pellagra, a condition linked to niacin deficiency.
• Treatment with niacin supplementation resulted in significant clinical improvement.
• The patient was discharged in stable condition following successful intervention.

Implications:

• This case underscores the importance of considering pellagra in the differential diagnosis for patients with altered mental status, particularly in at-risk populations.
• It highlights that pellagra has not been entirely eradicated and can still occur despite public health measures.
• Early recognition and prompt niacin administration are vital for managing pellagra and preventing severe outcomes.