Pellagra as the presenting manifestation of Crohn's disease

An 18-yr-old woman hospitalized with classical signs of pellagra was found to have Crohn's disease of the small and large bowel as well as malabsorption of nicotinic acid and iron. The symptoms of pellagra disappeared after intramuscular treatment with nicotinic acid, while the malabsorption was corrected following steroid therapy for the Crohn's disease. Pellagra should thus be added to the list of complications of Crohn's disease that are secondary to malabsorption. Although this complication seems to be very rare, it may be worthwhile to check for nicotinic acid malabsorption in untreated cases of Crohn's disease in order to determine its real prevalence.