Pellagra in Complex Clinical Settings: A Case Involving Bariatric Surgery, Whipple Procedure, and Alcohol Use...

Area of Science:

• Nutritional Science
• Internal Medicine
• Gastroenterology

Background:

• Pellagra, a disease caused by niacin (vitamin B3) deficiency, is characterized by diarrhea, dermatitis, and dementia.
• It is rarely seen in developed countries due to niacin's widespread presence in food.
• Risk factors include insufficient dietary intake or impaired niacin utilization.

Observation:

• A 50-year-old woman with a history of alcohol use disorder, gastric bypass, and Whipple procedure presented with symptoms of pellagra.
• Clinical findings included glossitis, cheilitis, skin rashes, edema, and altered mental status.
• Laboratory results revealed megaloblastic anemia, hypoalbuminemia, transaminitis, and deficiencies in niacin and vitamin D.

Findings:

• The patient was diagnosed with pellagra based on clinical and laboratory evidence.
• Initial treatment with vitamin supplementation showed some improvement, but the patient later developed encephalopathy and septic shock.
• Despite interventions, the patient ultimately succumbed to complications.

Implications:

• Pellagra, though rare in the US, should be considered in patients with multi-systemic symptoms, especially those with a history of bariatric or Whipple surgery and alcohol use.
• These patient populations are at increased risk for nutrient deficiencies and developing pellagra.
• Early diagnosis, niacin supplementation, nutritional support, and alcohol cessation are crucial for preventing severe complications and mortality.