The Guard, His Gauntlet and Goblet- An Atypical Presentation of Pellagra in a Chronic Alcoholic

Abstract

Alcoholism a chronic condition affects multiple organ systems including skin. Dermatological markers of alcohol abuse are invaluable. Despite this, association of skin diseases and alcohol misuse maybe overlooked or physicians fail to explore. Pellagra is a multifactorial disease caused by Niacin/Tryptophan deficiency. It exhibits photodermatitis, gastrointestinal and neuropsychiatric manifestations. Chronic alcoholics are at risk. Considering pellagra as differential diagnosis in chronic alcoholics with these symptoms is crucial. This disease is easily treatable but if missed proves fatal. Hence, its recognition is important in other clinical settings for comprehensive treatment. The pathognomonic presentation of Pellagra is the Casal necklace, but here we present a case of 34year old alcoholic with an atypical presentation of Pellagra. Chronic alcoholics need evaluation for Pellagra amongst other nutritional deficiencies which due to diverse presentation can be missed. Early diagnosis and treatment can avoid impending neuropsychiatric complications. Due to participation of numerous disciplines consultation liaison psychiatry is vital here. Keywords: Alcohol dependence, Alcohol cutaneous manifestations, Pellagra, Niacin deficiency, Alcohol biomarkers