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Pellagra is a disorder caused by a deficiency of niacin or tryptophan, manifested by characteristic dermatitis on sun-exposed areas of the skin. Gastrointestinal involvement is common, and symptoms include glossitis, stomatitis, and diarrhea. Neurologic symptoms can occur in some patients, including dementia, anxiety, depression, tremors, hyporeflexia and, in severe cases, encephalopathy. We present the case of a woman with hyperpigmentation and hyperkeratosis on sun-exposed areas of the skin along with progressive dysphagia. Notably, she did not report diarrhea or any neurologic or psychiatric symptoms. Her symptoms were most consistent with pellagra, and niacin supplementation was initiated, leading to recovery. This case report highlights that dermatitis and dysphagia, the main gastrointestinal manifestations, can be the only symptoms in patients with pellagra, requiring a high index of suspicion in dermatologic settings to diagnose and treat this fatal condition early.

Significance: The remarkable geometry of the axon exposes it to unique challenges for survival and maintenance. Axonal degeneration is a feature of peripheral neuropathies, glaucoma, and traumatic brain injury, and an early event in neurodegenerative diseases. Since the discovery of Wallerian degeneration (WD), a molecular program that hijacks nicotinamide adenine dinucleotide (NAD+) metabolism for axonal self-destruction, the complex roles of NAD+ in axonal viability and disease have become research priority. Recent Advances: The discoveries of the protective Wallerian degeneration slow (WldS) and of sterile alpha and TIR motif containing 1 (SARM1) activation as the main instructive signal for WD have shed new light on the regulatory role of NAD+ in axonal degeneration in a growing number of neurological diseases. SARM1 has been characterized as a NAD+ hydrolase and sensor of NAD+ metabolism. The discovery of regulators of nicotinamide mononucleotide adenylyltransferase 2 (NMNAT2) proteostasis in axons, the allosteric regulation of SARM1 by NAD+ and NMN, and the existence of clinically relevant windows of action of these signals has opened new opportunities for therapeutic interventions, including SARM1 inhibitors and modulators of NAD+ metabolism. Critical Issues: Events upstream and downstream of SARM1 remain unclear. Furthermore, manipulating NAD+ metabolism, an overdetermined process crucial in cell survival, for preventing the degeneration of the injured axon may be difficult and potentially toxic. Future Directions: There is a need for clarification of the distinct roles of NAD+ metabolism in axonal maintenance as contrasted to WD. There is also a need to better understand the role of NAD+ metabolism in axonal endangerment in neuropathies, diseases of the white matter, and the early stages of neurodegenerative diseases of the central nervous system. Antioxid. Redox Signal. 39, 1167–1184. [ABSTRACT FROM AUTHOR]

Photodermatoses represent a broad spectrum of skin diseases caused because of exposure to ultraviolet radiation. It is categorized mainly as idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. Despite being under the photodermatoses umbrella, the pathophysiology of each type of photodermatoses varies. We reported 4 cases of photodermatoses including azathioprine induced pellagra, adult onset actinic prurigo, and photoallergic contact dermatitis due to NSAIDs and cutting fluids. Photoprotection with the usage of photoprotective clothing, broad-spectrum sunscreen application and avoidance of photosensitizing drugs and chemicals are crucial. [ABSTRACT FROM AUTHOR]

Douglas Van Anden Frost (1910-1989) was a visionary in nutrition science, leaving an enduring legacy that reshaped the understanding of essential nutrients. From his early work on factor W and the discovery of niacin, which eradicated pellagra, to pioneering investigations into selenium's multifaceted role, Frost's unconventional thinking and meticulous research have significantly impacted human health. Collaborating with biochemist Raymond Shamberger (1934-2022), Frost challenged prevailing notions about selenium's carcinogenic potential, demonstrating its anticarcinogenic properties through groundbreaking research. Beyond the laboratory, Frost's work influences public health policies, emphasizing the interconnectedness of nutrients. This paper explores Frost's trajectory, emphasizing the importance of questioning paradigms, interdisciplinary insights, and dedicated experimentation in advancing nutrition science. Frost's enduring inspiration reminds us of the transformative power of curiosity in unraveling the mysteries of human health. [ABSTRACT FROM AUTHOR]

The oxidized form of nicotinamide adenine dinucleotide (NAD+) is a critical metabolite for living cells. NAD+ may act either as a cofactor for many cellular reactions as well as a coenzyme for different NAD+-consuming enzymes involved in the physiological homeostasis of different organs and systems. In mammals, NAD+ is synthesized from either tryptophan or other vitamin B3 intermediates that act as NAD+ precursors. Recent research suggests that NAD+ precursors play a crucial role in maintaining the integrity of the gut barrier. Indeed, its deficiency has been associated with enhanced gut inflammation and leakage, and dysbiosis. Conversely, NAD+-increasing therapies may confer protection against intestinal inflammation in experimental conditions and human patients, with accumulating evidence indicating that such favorable effects could be, at least in part, mediated by concomitant changes in the composition of intestinal microbiota. However, the mechanisms by which NAD+-based treatments affect the microbiota are still poorly understood. In this context, we have focused specifically on the impact of NAD+ deficiency on intestinal inflammation and dysbiosis in animal and human models. We have further explored the relationship between NAD+ and improved host intestinal metabolism and immunity and the composition of microbiota in vivo. Overall, this comprehensive review aims to provide a new perspective on the effect of NAD+-increasing strategies on host intestinal physiology. [ABSTRACT FROM AUTHOR]

Pellagra is caused by abnormal intake and/or use of nicotinic acid and is known in part to be induced by the use of medications such as isoniazid or pirfenidone. We previously investigated atypical phenotypes of pellagra, such as nausea, using a mouse model of pellagra and found that gut microbiota play an important role in the development of these phenotypes. Here, we investigated the effect of Bifidobacterium longum BB536 on pellagra-related nausea caused by pirfenidone in our mouse model. Our pharmacological data indicated that pirfenidone (PFD) causes modulation of the gut microbiota profile, which appeared to play an important role in the development of pellagrarelated nausea. A gut microbiota-mediated protective effect of B. longum BB536 against nausea caused by PFD was also identified. Finally, the urinary ratio of nicotinamide/N-methylnicotinamide was shown to be a biomarker of pellagra-like adverse effects induced by PFD, and it may contribute to the prevention of these effects in patients with idiopathic pulmonary fibrosis. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 6-year-old girl with persistent exfoliative dermatitis. The girl presented with painful rashes on her neck, chest, axillary, and abdominal region, along with abdominal pain. Despite treatment for eczema, her condition did not improve. Further investigation revealed that she had a deficiency in vitamin B3 (niacin), leading to a diagnosis of pellagra. Treatment with oral niacinamide resulted in complete resolution of the rash and abdominal pain. Pellagra is a condition that was historically characterized by dermatitis, diarrhea, dementia, and death, but is now rare in developed countries due to fortification of flour with vitamin B3. However, it is still endemic in certain areas due to poor nutrition. [Extracted from the article]

Pellagra is a nutritional disorder characterized clinically by the four Ds: dermatitis, diarrhea, dementia, and severe systemic photosensitivity manifesting as death. The disorder results from a deficiency of niacin or its precursor tryptophan and is mainly associated with compromised dietary intake of niacin and tryptophan or excessive intake of leucine (a natural antagonist). Other causes include chronic alcohol intake, malabsorption, metabolic disorders, and the administration of certain medications. Herein, we report the clinical and dermoscopic findings in a twenty-yearold male with seizure disorder presenting with carbamazepine-induced pellagrous dermatitis that resolved after the administration of niacin. [ABSTRACT FROM AUTHOR]

Background Primary nutritional pellagra is still an endemic problem in many developing countries but surprisingly it had not been reported in Iraq even with the endless wars and prolonged sanctions that Iraqi people had faced. All cases of pellagra that were seen since 1978 were mostly secondary to chronic alcohol intake but not nutritional and rarely to anti tuberculosis therapy. Objective To report and evaluate pellagra cases in regards to their triggering factors, clinical picture and therapy. Methods This case series descriptive study was conducted in Dermatology Centre, Baghdad Medical City, Baghdad, Iraq during the period from December 2013 to January 2019. All pellagra cases were collected, documented and evaluated clinically. All triggering factors were looked for like alcohol intake, nutritional problem, drug intake or any family history of the same disease. Niacin and other B vitamins were given as therapeutic and diagnostic agents. Results Over the period of 6 year, a total of 11 patients with pellagra were seen. All patients were males, their ages range from 5 - 65 years with mean age of 42.5 years. Seven out of eleven cases were caused by chronic alcoholism, three cases were caused by isoniazid therapy for tuberculosis and only one case was caused by Hartnup disease. But none of the cases were primary nutritional pellagra. The main clinical picture was photosensitivity as a burn like dermatosis but not Wernicke's encephalopathy. Conclusion Although living in a developing country with many wars and sanctions that lasted for decades, Iraqis rarely if ever suffered from primary nutritional pellagra, probably because the Iraqi cuisine depends on rice and wheat as a staple food as opposed to other developing countries that depend on corn which is a poor source of niacin. Thus, all cases of pellagra were secondary, mainly to chronic alcoholism in sunny climate. The florid burn like picture of photosensitivity, put pellagra as one of the main causes of burn like dermatosis but no obvious mainly neurological manifestation as seen in western countries. [ABSTRACT FROM AUTHOR]

Pellagra, a deficiency of niacin (Vitamin B3), is a potential secondary complication of anorexia nervosa (AN) resulting from restricted nutrient consumption. Symptoms observed in patients with pellagra (such as diarrhea, dermatitis, dementia, and death) can often overlap with or be affected by AN status. This article presents the largest literature review to date on symptoms observed with AN-induced pellagra, treatment regimens, and patient outcomes. An English literature search was performed using the keywords “pellagra” and “anorexia”, yielding seven female case reports. The most prevalent symptom (100%) reported was erythema of the face, neck, and arm regions. Symptoms traditionally associated with pellagra were not identified as frequently, such as diarrhea (29%). The most common treatment regime included both Vitamin B supplementation and dietary advice (83%), with all patients recorded recovering from pellagra. AN and pellagra may affect the symptomatic presentation of its counterpart disease, providing a challenge to practitioners tasked with diagnosing patients. Future studies are needed to clarify the symptomatic development of the diseases concurrently, and best practices in treatment and diagnosis.

This paper argues that the public health conceptual framework of epidemiologist Geoffrey Rose, first published as “Sick Individuals and Sick Populations” in 1985, provides a useful way to critically analyze prevention and control options for modern non-communicable diseases (NCD) and their forerunner, obesity, a pandemic now engulfing Lower-and-Middle-Income-Countries. That framework is based on the notions of primordial, primary, secondary and tertiary prevention—the full spectrum of “more upstream and more downstream” approaches, each with its pros and cons. These are illustrated using the pellagra epidemic in the southeastern USA from 1900 to the 1940s, which still has much to teach us about these same basic policy options for controlling the modern NCD pandemic. In particular, Rose’s dictum, “Seek the causes of (population) incidence, not of (individual) cases”, points up the compelling advantages of upstream prevention for controlling both epidemics.

Large plots of maize in agricultural landscapes are associated with reduced reproductive output of females and impaired population development of free-living populations of European brown hares (Lepus europaeus, Pallas 1778). We investigated in captive brown hares experimentally whether these effects could result from an undersupply of niacin due to a suspected maize-biased diet in such areas. We repeatedly mated adult female hares, fed ad libitum either with a niacin deficient pellet mainly consisting of maize plant parts, or with the same pellet enriched with niacin to meet physiological requirements. We measured effects of the experimental feeding on body mass of females, reproductive output, growth and survival of leverets. We found significantly higher body mass of females fed the control pellet, and faster body mass gain of their leverets until standardized weaning. We found no significant difference between niacin deficient and control diet groups in reproductive output of females and survival rates of leverets. Our results show that even a diet severely depauperate of niacin affects reproductive success of female brown hares only slightly, presumably because of sufficient conversion of tryptophan to niacin, or of additional supply of niacin by caecal microorganism.

Background: Pellagra caused by niacin deficiency in alcoholics can be easily misdiagnosed because of similar symptoms to other alcohol‐related diseases and the lack of the classical triad of signs. Aim: This study aimed to define the clinical presentation of alcoholic pellagra for early diagnosis and timely treatment. Methods: The clinical data of 16 alcohol‐dependent patients who had pellagra and treated in our hospital from January 2002 to December 2019 were retrospectively analyzed. The local medical ethics committee approval (Medical Ethics Committee of Affiliated Hospital of XuZhou Medical University, XYFY2020‐KL247‐02) for this study has been obtained. Results: The main complaints of the 16 patients were skin lesions (six cases), diarrhea (six cases), and mental disorders (four cases). Then, 13 cases had typical skin lesions, and 3 patients had a full spectrum of diarrhea, dementia, and dermatitis (3D). In terms of the main diagnosis, 2 patients had pellagra and Wernicke's encephalopathy, 3 patients had pellagra and alcohol‐withdrawal syndrome, and the other patients had pellagra. After sufficient amounts of niacin and multivitamin B were given, clinical symptoms improved rapidly, and no sequelae were observed during follow‐up. Conclusions: Pellagra is rarely manifested as a full 3D spectrum, with only one or two characteristics, which lack diagnostic specificity, especially in individuals with alcoholism. Physicians should maintain a high degree of suspicion of niacin deficiency in alcoholics. Alcohol‐dependent patients with pellagra may be accompanied by complications of Wernicke's encephalopathy and alcohol‐withdrawal syndrome. Prompt identification and timely treatment with a sufficient amount of niacin in combination with other vitamins and a certain amount of Zn can achieve a good prognosis of pellagra. [ABSTRACT FROM AUTHOR]

Currently pellagra is usually the subject of dermatological or non-dermatological case reports. Since the first description of the disease, its cause has remained unknown for many years. There were no known methods of prevention and treatment. For two centuries, pellagra was an incurable disease and caused several hundred thousand deaths in Europe and North America. Research by clinicians and scientists has made it possible to refute the common theory of the infectious etiology of the disease and link the disease epidemic to maize, which was then the primary source of food for the poor. Consumption limited to this grain resulted in an extreme deficiency of niacin (vitamin B3) and symptoms of pellagra. Niacin supplementation caused the lesions to regress, and became crucial to combat the epidemic. The article presents the first descriptions, the greatest outbreaks of the epidemic and the stormy process of discovering data on the etiology of pellagra, as well as typical clinical features of the diseases.

Pellagra is mainly caused by a niacin deficiency or its precursor amino acid, tryptophan. We report a case of a male patient, 34 years old, a chronic alcoholic with delirium tremens and gastrointestinal symptoms (diarrhea, inappetence, and heartburn). He presented erythematous-brown, scaly, and well-defined plaques dispersed throughout the integument (photo-exposed areas) for 2 months that evolved with ulceration and hematic crusts. The case was diagnosed as pellagra associated with secondary bacterial infection and treated with rest, an unrestricted diet, B-complex replacement, abstention from alcohol, restriction of sun exposure, and broad-spectrum antibiotic therapy. The treatment allowed for significant improvement of symptoms in one week. Aspects of the pathophysiology and differential diagnoses of this condition are discussed, reinforcing the importance of considering pellagra in diagnosing patients with skin lesions associated with risk factors for malnutrition.

This paper is a microbiological voyage throughout the main discoveries and research activities of scholars who studied or taught in this field at Padova University during its 800-year history. The ancient practice of variolization, the so-called miracle of Legnaro and the pellagra debate, whose observations and investigations were driven at Padova even before microbiology was established as a scientific discipline, along with the modern era research activities in the field of agricultural, environmental and food microbiology, undoubtedly suggest the hallmark and everyday role played by microbes in overwhelmingly global, but profoundly human, adventures. [ABSTRACT FROM AUTHOR]

Niacin (Vitamin B3) plays a crucial role as a vitamin in cellular energy production, metabolism, and DNA repair. A severe deficiency of this vitamin can lead to pellagra, which is characterized by dermatitis, dementia, diarrhoea and eventually death if untreated. A 68-year-old woman with a poor socioeconomic background presented with photosensitive dermatitis, fever, abdominal pain, and diarrhoea. Her urine changed to port wine colour following sun exposure. Porphyria cutanea tarda was excluded in the absence of demonstrable urine spectrophotometry. A diagnosis of pellagra was made, and timely management led to a complete cure. Proper diagnosis and effective treatment of pellagra are imperative as this condition can be life-threatening if left untreated., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Pellagra is a disorder caused by a deficiency of niacin or tryptophan, manifested by characteristic dermatitis on sun-exposed areas of the skin. Gastrointestinal involvement is common, and symptoms include glossitis, stomatitis, and diarrhea. Neurologic symptoms can occur in some patients, including dementia, anxiety, depression, tremors, hyporeflexia and, in severe cases, encephalopathy. We present the case of a woman with hyperpigmentation and hyperkeratosis on sun-exposed areas of the skin along with progressive dysphagia. Notably, she did not report diarrhea or any neurologic or psychiatric symptoms. Her symptoms were most consistent with pellagra, and niacin supplementation was initiated, leading to recovery. This case report highlights that dermatitis and dysphagia, the main gastrointestinal manifestations, can be the only symptoms in patients with pellagra, requiring a high index of suspicion in dermatologic settings to diagnose and treat this fatal condition early., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mengistu, Ali, Alemu and Melese.)

Public health nutrition concerns fall within the general topic of the Social Hygiene Movement of the late 19th andearly 20th centuries. The public health nutrition discourse focuses on several priority topics: an almost all plant-based diet, lack of culinary know-how, the consumption of rotten corn as the cause of pellagra. Beyond various issues potentially resolvable by means of a better education, public nutrition hygiene poses the question of the actual economic capacity of the peasant household. When dealing with the subject of public health nutrition, the Romanian hygiene doctors will always take into consideration its ideological connotations, calling to mind the need to both boost population growth and ensure public good health, which is inextricably linked to the country’s economic and military resources. The differences which exist between the advocates of the Social Hygiene Movement are determined by their acceptance (or not) of the state’s responsibility for the peasantry as the largest part of its citizens, and all the more so as their access to staple foods may eventually facilitate access to land ownership.

Tryptophan is an essential amino acid, which is not only a building block for protein synthesis, but also a precursor for the biosynthesis of co-enzymes and neuromodulators, such as NAD/NADP(H), kynurenic acid, melatonin and serotonin. It also plays a role in immune homeostasis, as local tryptophan catabolism impairs T-lymphocyte mediated immunity. Therefore, tryptophan plasmatic concentration needs to be stable, in spite of large variations in dietary supply. Here, we review the main checkpoints accounting for tryptophan homeostasis, including absorption, transport, metabolism and elimination, and we discuss the physiopathology of disorders associated with their dysfunction. Tryptophan is catabolized along the kynurenine pathway through the action of two enzymes that mediate the first and rate-limiting step of the pathway: indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO). While IDO1 expression is restricted to peripheral sites of immune modulation, TDO is massively expressed in the liver and accounts for 90% of tryptophan catabolism. Recent data indicated that the stability of the TDO protein is regulated by tryptophan and that this regulation allows a tight control of tryptophanemia. TDO is stabilized when tryptophan is abundant in the plasma, resulting in rapid degradation of dietary tryptophan. In contrast, when tryptophan is scarce, TDO is degraded by the proteasome to avoid excessive tryptophan catabolism. This is triggered by the unmasking of a degron in a non-catalytic tryptophan-binding site, resulting in TDO ubiquitination by E3 ligase SKP1-CUL1-F-box. Deficiency in TDO or in the hepatic aromatic transporter SLC16A10 leads to severe hypertryptophanemia, which can disturb immune and neurological homeostasis.

The NAD(P)HX repair system is a metabolite damage repair mechanism responsible for restoration of NADH and NADPH after their inactivation by hydration. Deficiency in either of its two enzymes, NAD(P)HX dehydratase (NAXD) or NAD(P)HX epimerase (NAXE), causes a fatal neurometabolic disorder characterized by decompensations precipitated by inflammatory stress. Clinical findings include rapidly progressive muscle weakness, ataxia, ophthalmoplegia, and motor and cognitive regression, while neuroimaging abnormalities are subtle or nonspecific, making a clinical diagnosis challenging. During stress, nonenzymatic conversion of NAD(P)H to NAD(P)HX increases, and in the absence of repair, NAD(P)H is depleted, and NAD(P)HX accumulates, leading to decompensation; however, the contribution of each to the metabolic derangement is not established. Herein, we summarize the clinical knowledge of NAXE deficiency from 30 cases and lessons learned about disease pathogenesis from cell cultures and model organisms and describe a metabolomics signature obtained by untargeted metabolomics analysis in one case at the time of crisis and after initiation of treatment. Overall, biochemical findings support a model of acute depletion of NAD+, signs of mitochondrial dysfunction, and altered lipidomics. These findings are further substantiated by untargeted metabolomics six months post-crisis showing that niacin supplementation reverses primary metabolomic abnormalities concurrent with improved clinical status. [ABSTRACT FROM AUTHOR]

Between the end of the 18th century and the beginning of the 20th, some countries of the world had to face a profoundly serious vitamin deficiency, pellagra. Caused by a monotropic diet of maize, the “poverty’s disease” led the most indigent peasant populations to a deep failure of vitamin B3 and tryptophan. In northern Italy and particularly in Veneto, pellagra remained endemic until just after the First World War. This study retraces the epidemiological, social and cultural mechanisms that led to the primary spread of pellagra among women during their reproductive age. [ABSTRACT FROM AUTHOR]

Niacin deficiency causes pellagra, the symptoms of which include dermatitis, diarrhoea and dementia. Investigating the mechanism underlying these phenotypes has been challenging due to the lack of an appropriate animal model. Here, we report a mouse model of pellagra-related nausea induced by feeding mice a low-niacin diet and administering isoniazid (INH), which is thought to induce pellagra. Mice fed a normal or low-niacin diet received INH (0·3 or 1·0 mg/mg per animal, twice daily, 5 d), and nausea was evaluated based on pica behaviour, which considered the rodent equivalent of the emetic reflex. Furthermore, the effect of therapeutic niacin administration on nausea was evaluated in this model. Urinary and hepatic metabolite levels were analysed by LC coupled with MS. INH-induced pica was observed in mice fed a low-niacin diet but not in those fed a normal diet. Levels of urinary metabolites, such as 1-methyl-2-pyridone-5-carboxamide, kynurenic acid and xanthurenic acid, were significantly reduced in the mice treated with INH compared with those that did not receive INH. Furthermore, niacin supplementation prevented pica and restored the levels of some metabolites in this mouse model. Our findings suggest that INH-related nausea is pellagra-like. We also believe that our newly established method for quantifying pica is a useful tool for investigating the mechanisms of pellagra-related nausea. [ABSTRACT FROM AUTHOR]

Pellagra is caused by an abnormal intake and/or use of niacin, but its phenotypes are diverse. The phenotypes of pellagra can also be atypical, such as nausea. We previously reported a mouse model of pellagra-related nausea. However, the mechanism of this model is unclear. In this study, we found that the gut microbiota, which is thought to be a source of niacin, played an important role in the development of pellagra-related nausea in germ-free mice. We also investigated the gut microbiome. We compared urinary niacin metabolite levels and the dermal response between mice fed a normal diet and those fed a low-niacin diet to investigate the putative trigger of pellagra. Epoxyeicosatrienoic and hydroxyeicosatetraenoic acid levels were higher in mice fed a low-niacin diet compared with those fed a normal diet. Furthermore, histological studies indicated a dermatological response to the low-niacin diet. Interestingly, higher levels of oxidised fatty acids in response to the germ-free state were also observed. These findings indicate successful establishment of our newly established mouse model of pellagra via the gut microbiota. We believe that this model could enable the discovery of the putative cause of pellagra and phenotypes of pellagra that have not been recognised yet. [ABSTRACT FROM AUTHOR]

Despite characteristic features, psoriasis can mimicother dermatologic conditions, such as seborrheicdermatitis, lichen simplex chronicus, and certainnutritional deficiencies such as pellagra. We present apatient with a longstanding history of severe plaquepsoriasis who presented with disfiguring scaly plaquesinvolving greater than 80% body surface area. Thepatient’s disease was minimally responsive to multipletherapies. Repeat punch biopsies demonstratedparakeratosis, psoriasiform hyperplasia, and dilatedblood vessels consistent with psoriasis. Given atypicalclinical features and overall poor treatment responseadditional work up was obtained. A serum nutritionalpanel was consistent with niacin deficiency andthe patient later revealed extensive alcohol intake.A diagnosis of concurrent pellagra was made andthe patient was started on niacin supplementationand instructed to reduce alcohol intake, whilecontinuing adalimumab and high potency topicalsteroids. Within two weeks, his disease had markedlyimproved. Pellagra presents characteristically with aphotosensitivity dermatitis that may appear clinicallyand histologically similar to psoriasis. It is importantto maintain an index suspicion for a secondarypathology in treatment-resistant psoriasis.

Abstract Background Pellagra is a nutritional disorder due to deficiency of vitamin B3 (niacin) which is characterized by dermatitis, dementia, diarrhea, and death. The most common site of dermatitis in pellagra is the Casal necklace; however, in this case, the presentation of dermatitis is in unusual sites. Therefore, mucocutaneous signs play a major role in diagnosing the condition. The clinical features of pellagra begin with gastrointestinal symptoms followed by neurological symptoms which are subtle and non-specific. But if misdiagnosed and untreated, it can progress to death from multiorgan failure. Case presentation A 46-year-old Indian farmer, chronic alcoholic of 20 years duration, presented to the hospital with the complaints of darkening and thickening of the skin over the left upper chest and shoulder, epigastric region, left arm and forearm, and right arm and forearm for a period of 4 months with mild cognitive decline. His blood parameters revealed moderate anemia with microcytic hypochromic blood picture and decreased MCV, MCH, and MCHC values. A diagnosis of pellagra was built clinically after exclusion of other causes and has been treated with nicotinamide and had drastic improvement on follow-up. Conclusion The unusual site of pellagra presentation is rare; however, the uncommon presentation of a common disease is always to be considered for diagnosing the disease at the early stage. The neuropsychiatric symptoms of the pellagra in a known case of chronic alcoholic are not well defined, and if untreated, it may progress to stupor and coma and ultimately death. Hence, appropriate diagnosis and earlier management helps in the prevention of various life-threatening complications of any disease.

Currently pellagra is usually the subject of dermatological or non-dermatological case reports. Since the first description of the disease, its cause has remained unknown for many years. There were no known methods of prevention and treatment. For two centuries, pellagra was an incurable disease and caused several hundred thousand deaths in Europe and North America. Research by clinicians and scientists has made it possible to refute the common theory of the infectious etiology of the disease and link the disease epidemic to maize, which was then the primary source of food for the poor. Consumption limited to this grain resulted in an extreme deficiency of niacin (vitamin B3) and symptoms of pellagra. Niacin supplementation caused the lesions to regress, and became crucial to combat the epidemic. The article presents the first descriptions, the greatest outbreaks of the epidemic and the stormy process of discovering data on the etiology of pellagra, as well as typical clinical features of the diseases. [ABSTRACT FROM AUTHOR]

Pellagra is a clinical syndrome resulting from niacin deficiency with variety of manifestations. Azathioprine is among drugs that can lead to such condition. Physicians should be aware as proper management can lead to full resolution. [ABSTRACT FROM AUTHOR]

Abstract Isoniazid preventive therapy in malnourished patients with Crohn's disease has a potential of inducing pellagra but still a very rare situation. No cases of isoniazid‐induced pellagra in patients with Crohn's disease were reported in the literature. Pellagra can be easily treated if timely diagnosed.

Introduction: Celiac disease is a consequence of certain hereditary predisposition resulting in permanent gluten intolerance. Gluten is a protein found in wheat, barley, rye, and oats. First lesions appear in the mucose of the proximal part of the small intestine. This leads to the decreased absorption of nutrients and consequential nutrition deficit. Niacin and tryptophan absorption is decreased which is one of the reasons for pellagra occurrence. The symptoms of pellagra are dermatitis, diarrhea, and dementia. If not treated it may cause disorientation, confusion, delirium, and ultimately death. Case report: Female patient, 33, works in a shoe factory, mother of two, presents with her mother. Her mother noticed she has become disinterested, forgetful, moody, silent with no initiative. She suffers from celiac disease since childhood and she`s been using cornbread for years. Since a month ago she started noticing skin lesions and frequent diarrheas. The main reason for her visit is that she got very scared the day before because she couldn't remember how to find her way home. Due to her basic condition, she was diagnosed with pellagra induced dementia, due to the B vitamin deficienecy (B1, B2, B3, B6, B12). Followed by an intensive vitamin therapy and adequate nutrition, recommended by a nutritionist, dementia symptoms withdrew. Conclusion: A patient`s history with a typical clinical presentation is good enough to suspect pellagra. Knowing that celiac disease is the reason the patient was using cornbread (which lacks vitamin B) and at the same time, the patient was experiencing diarrheas are good enough reasons to suspect pellagra. The treatment of celiac disease should include consultations of a gastroenterologist and nutritionist. Should there be any other disease complications a dermatologist, infectologist, neurologist, and psychiatrist should be consulted.

Abstract Pellagra is a clinical syndrome resulting from niacin deficiency with variety of manifestations. Azathioprine is among drugs that can lead to such condition. Physicians should be aware as proper management can lead to full resolution.

Pellagra is a multisystemic disease caused by niacin deficiency and characterized by diarrhea, dementia, dermatitis and, death. The lesions appear as hyperkeratotic, sharply demarcated erythematous plaques and bullae symmetrically distributed in photo-exposed areas. Poverty, hunger, anorexia and, alcoholism are among the most common reasons for diminished gastrointestinal (GIS) niacin uptake. Also rarely, GIS operations may end up with niacin deficiency. A 65-year-old man applied to our clinic with complaints of blisters in his feet, discoloration in his face and hands along with a mood alteration. The lesions were violaceous and sharply demarcated in a photosensitive distribution. He had a history of GIS surgery and he was diagnosed with pellagra disease by clinicopathologic evaluation. Pellagra responds excellently to the treatment, but it has a fatal course when overlooked. Herein, we present this case to underline the importance of keeping in mind that pellagra may develop after gastrointestinal surgeries. [ABSTRACT FROM AUTHOR]

Pellagra is a rare disease caused by niacin deficiency or a disruption of its metabolism. Its manifestations are dermatitis with pronounced photosensitivity, gastrointestinal symptoms, and neuropsychiatric ailments. Currently pellagra is developed in people who chronically abuse alcohol or are treated with medications from specific pharmacological groups (immunosuppressive and anti-tuberculosis drugs). Although the root cause of the disease was established in the mid-twentieth century, a detailed explanation of the processes leading to the development of symptoms has not yet been proposed. They include complex abnormalities at the molecular, metabolic, and immunological levels. Diagnostics is based primarily on the clinical presentation of the disease, while auxiliary tests play secondary role. The low prevalence of the disease, meaning that physicians are unfamiliar with its recognition, often leads to delays in diagnosis and appropriate treatment. The therapy is causal and based on administering niacinamide. Failure to implement treatment in the early stages of the disease leads to the patient's death. The aim of this literature review is to summarize the current state of knowledge on the pathomechanisms of pellagra, highlighting the clinical implications, and key elements of diagnostic and therapeutic management that are important in the treatment of pellagra patients. [ABSTRACT FROM AUTHOR]

This paper is a microbiological voyage throughout the main discoveries and research activities of scholars who studied or taught in this field at Padova University during its 800-year history. The ancient practice of variolization, the so-called miracle of Legnaro and the pellagra debate, whose observations and investigations were driven at Padova even before microbiology was established as a scientific discipline, along with the modern era research activities in the field of agricultural, environmental and food microbiology, undoubtedly suggest the hallmark and everyday role played by microbes in overwhelmingly global, but profoundly human, adventures.

Objective: Pellagra is a nutritional deficiency disease associated with niacin (vitamin B3) deficiency. The history of pellagra is well documented for Europe and the USA, but less is known about the prevalence in sub-Saharan African countries. This study documents the history of pellagra in South Africa, as diagnosed based on dermatological symptoms.Design: Scoping review of information from scientific databases, library archives, other archives and record services and from Statistics South Africa.Setting: South Africa, 1897-2019.Participants: South African.Results: Pellagra was first officially recorded in South Africa in 1906, but there are earlier indications of the disease. The prevalence of pellagra peaked after it was all but eradicated in the USA and Europe. Pellagra was never as prevalent in South Africa as in Europe, the USA and Egypt, where special hospitals for pellagrins were established. However, studies on urinary excretion of metabolites conducted in 1960s and 1970s suggested a high prevalence of subclinical (sub-pellagra) niacin deficiency, especially in previously disadvantaged Black populations. As in Europe and the USA, pellagra was associated with poverty and an overdependence on maize as staple food. Malnutrition was the main cause of the disease, but alcohol abuse might have been a contributing factor. In South Africa, reports of pellagra had declined by the late 1980s/early 1990s and hardly any cases were reported by the year 2000.Conclusions: Although pellagra, diagnosed based on dermatological symptoms, appears to be largely eradicated in South Africa, it does not rule out the potential for subclinical niacin deficiency. [ABSTRACT FROM AUTHOR]

Niacin or tryptophan deficiency causes pellagra. Isoniazid interferes with the absorption of niacin and individuals on Isoniazid (INH) are at risk of pellagra. Isoniazid preventive therapy (IPT) is the administration of isoniazid to immunosuppressed individuals to prevent active tuberculosis (TB). IPT, in sub-Saharan Africa, the region worst hit by HIV and with a high TB prevalence, is recommended. A 40-year-old, HIV+ Zambian woman on Antiretroviral therapy for five years and IPT for three months presented with a four-day history of constipation, generalised body weakness and irrelevant talk. She complained of a generalised rash, sloughing off, and darkening of the skin on the face, neck, forearms, and dorsum of both feet. A physical examination revealed features of pellagra, and rapid response to oral niacin reaffirmed the diagnosis of pellagra. Unlike typical cases of pellagra presenting with the classic 3 Ds of Diarrhoea, Dementia and Dermatitis, our patient presented with constipation instead of diarrhoea. A consideration of Pellagra in HIV+ patients on IPT whose diet is mostly maize-based will be beneficial, even if the classic 3 Ds of diarrhoea, dementia, and dermatitis are not wholly present. A timely diagnosis and prompt treatment of pellagra can be lifesaving. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: pellagra is a systemic disease due to deficiency of vitamin B3 or tryptophan, its precursor. Vitamin B3 is needed for several metabolic processes, cell signaling, and DNA repair. It is characterized by a classic tetrad of dermatitis, diarrhea, dementia, and death. Pellagra is considered rare nowadays; however, due to the popularity of restrictive diets without necessary supplementation such us veganism, there has been an increase in cases in recent years. Clinical case: we report the case of a young strict vegan female patient in which a pellagra diagnosis was made, and early treatment was administered with an excellent outcome. Discussion: the interest of this case lies in the importance of clinical suspicion and directed history taking focused on social and nutritional factors, as adapted for the current times, in order to make the diagnosis of a rare, subdiagnosed disease that is life-threatening if treatment is delayed. [ABSTRACT FROM AUTHOR]