Pellagra Pre-Goldberger: Rupert Blue, Fleming Sandwith, and The "Vitamine Hypothesis".

The conquest of pellagra is commonly associated with one name: Joseph Goldberger of the US Public Health Service, who in 1914 went south, concluded within 4 months that the cause was inadequate diet, spent the rest of his life researching the disease, and--before his death from cancer in 1929--found that brewer's yeast could prevent and treat it at nominal cost. It does Goldberger no discredit to emphasize that between 1907 and 1914 a patchwork coalition of asylum superintendents, practicing physicians, local health officials, and others established for the first time an English-language competence in pellagra, sifted through competing hypotheses, and narrowed the choices down to two: an insect-borne infection hypothesis, championed by the flamboyant European Louis Westerna Sambon, and the new "vitamine hypothesis," proffered by Casimir Funk in early 1912 and articulated later that year by two members of the American Clinical and Climatological Association, Fleming Mant Sandwith and Rupert Blue. Those who resisted Goldberger's inconvenient truth that the root cause was southern poverty drew their arguments largely from the Thompson-McFadden Pellagra Commission, which traces back to Sambon's unfortunate influence on American researchers. Thousands died as a result.

Pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo : retrospective study from 1997 to 2017.

OBJECTIVE: The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcome and to document the causes of pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo. METHODS: This retrospective study examined the records of patients seen for outpatient consultation and/or hospitalization in the three public dermatology departments of Lomé from January 1997 to September 2017. RESULTS: During the study period, 178 (0.4%) of 47,219 patients seen in these dermatology departments consulted for pellagra or pellagra-like erythema; 159 (89.3%) had pellagra-like erythema. The patients' mean age was 45.8±16 years, and the sex ratio (M/F) 1.8. All patients had at least one site of cutaneous involvement, nearly always erythematous or pigmented lesions in the photo-exposed areas (99.4% of cases). Gastrointestinal and neurological signs were dominated respectively by diarrhea (12.4 % of cases), peripheral neuropathies (8.4% of cases) and insomnia (8.4% of cases). The main causes identified were alcoholism (42.1% of cases) and nutritional deficiency (6.7% of cases). Five of 178 patients were infected with HIV. All patients were treated with nicotinamide and multivitamin supplementation. No deaths were recorded during follow-up. CONCLUSION: Our results document the extreme rarity of pellagra-like erythema/pellagra. Its two main causes remain alcoholism and nutritional deficiency. Moreover, its prognosis is good when treated quickly and adequately.

Pellagra in 2 homeless men.

Pellagra is a nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. Untreated, pellagra is fatal. Two cases of pellagra in contemporary homeless people are described. Complete evaluation supported a clinical diagnosis of pellagra after exclusion of other possibilities. Signs and symptoms resolved after institution of niacin therapy and change in diet. Appropriate suspicion for a diagnosis of pellagra requires attention to a combination of socioeconomic and behavioral risk factors for nutritional deficiency. The combination of homelessness, alcohol abuse, and failure to eat regularly--particularly, failure to make use of shelter-based meal programs--may identify people at special risk in contemporary settings.

Acute hemorrhagic pellagra in an Albanian refugee.

We report a peculiar case of hemorrhagic pellagra in an exhausted Albanian refugee who had walked for 3 days under sunny skies on his way from his country to Greece. The peculiarities of the case are the fulminant course of the disorder; the "terrifying" appearance of the patient (initially he was admitted to an emergency unit); the gangrenous appearance of the hemorrhagic lesions of the palms and fingernails; the disturbed hepatic function that gradually returned to normal; and the absence of a history of alcohol consumption, alcohol malabsorption, or drug intake.

A case of pellagra associated with megaduodenum in a young woman.

Pellagra is a rare condition that has been known for many years to be related to niacin deficiency. Clinically known as the 4 "D" symptoms for dermatitis, diarrhea, dementia, and even death, skin changes remain one of the most important features of this pathology, leading frequently to the diagnosis. Pellagra is mostly seen in poor populations with a deficient diet; still, it is sporadically observed in developed countries, usually in association with digestive disorders. We report a new case of pellagra in a 29-year-old woman in whom the diagnosis of megaduodenum was made. Megaduodenum is a rare condition that can be idiopathic or secondary to visceral myopathy or neuropathy. Parenteral supplementation with niacin has resulted in a quick response of dermatological and psychiatric symptoms. To our knowledge, no case of pellagra due to megaduodenum has been reported in literature.

[Wernicke's encephalopathy associated with pellagra encephalopathy: rare and unusual complication in an elderly woman hospitalized for aspiration pneumonia]. / Encéphalopathie de Gayet Wernicke associée à une encéphalopathie pellagrique : complication rare et inhabituelle chez une femme âgée hospitalisée pour pneumopathie d'inhalation.

INTRODUCTION: Wernicke's encephalopathy caused by thiamine deficiency is typically characterised by a mental-status change, oculomotor dysfunction and an ataxia. Pellagra is the clinical presentation of niacin deficiency comprising cutaneous, gastrointestinal and neuropsychiatric manifestations. OBSERVATION: We report a case of encephalopathy due to dual vitamin deficiency of both thiamine (vitamin B1) and niacin (vitamin PP) in an 80-year-old women, hospitalized for severe sepsis caused by aspiration pneumonia. Severe malnutrition and alcohol consumption pointed to a diagnosis of vitamin deficiency. The clinical presentation and magnetic resonance imaging (MRI) were compatible with Wernicke's encephalopathy that remained irreversible despite vitamin B1 supplementation. Niacin supplementation allowed for complete regression of the observed symptoms compatible with niacin deficiency. CONCLUSION: Malnourished and alcoholic patients showing signs of encephalopathy should receive supplemental multivitamins including niacin.

Caso 6 Mulher, 54 anos, procurou atenção básica em município de Minas Gerais com queixa de lesões descamativas e pruriginosas em área de exposição solar, há cerca de 2 meses / Case 6

Mulher, 54 anos, procurou atenção básica em município de Minas Gerais com queixa de lesões descamativas e pruriginosas em área de exposição solar, há cerca de 2 meses. Essa é a segunda vez que manifesta estes sinais e não sabe precisar há quanto tempo ocorreu o primeiro episódio. Relata que no intervalo entre eles não apresentou qualquer tipo de lesão cutânea. A paciente é alcoolista, tabagista, hipertensa e não faz uso de medicamentos.

Pellagra: a rare complication of anorexia nervosa.

Pellagra is a potentially fatal, nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. A case of pellagra in a 14-year-old girl with anorexia nervosa is presented. Signs and symptoms of pellagra were resolved after niacin therapy and dietary treatment.

Pellagra: dermatitis, dementia, and diarrhea.

Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 "D's": diarrhea, dermatitis, dementia, and death. Diagnosis of pellagra is difficult in the absence of the skin lesions, and is often facilitated by the presence of characteristic ones. The dermatitis begins as an erythema. Acute pellagra resembles sunburn in its first stages, but tanning occurs more slowly than typically in sunburn. Exacerbation follows re-exposure to sunlight. In this work we review the findings of this once mysterious disorder, one that still challenges clinicians world-wide.

[Pellagra: diagnosis still valid]. / Pelagra: diagnóstico aún vigente.

Pellagra, caused by niacin deficiency, was described in 1730 by Casal in Spain and is specially frequent in alcoholics, subjects with malabsorption and mentally ill patients. We report three alcoholic patients (one female) aged 32, 57 and 26 years old, presenting with the typical desquamative and hyperpigmented lesions in exposed areas. One patient also had mental changes characterised by aggressiveness and clouding of consciousness. A diagnosis of pellagra was reached and treatment with nicotinic acid was started with good clinical response in all cases.