[An Uncommon Diagnosis]. / Eine nicht alltägliche Diagnose.

We report on a 61-year-old patient who suffered from severe protein-energy malnutrition due to an inadequately treated exocrine pancreatic insufficiency. In this context, a thiamine deficiency was not recognized and there were clinical manifestations of beriberi disease with decompensated biventricular heart failure. In the course of time, a manifest niacin deficiency (pellagra) with dermatitis, diarrhea and persistent delirium occurred, which was recognized and could be treated. We highlight differential diagnostic considerations about the consequences and the treatment of malnutrition, with special focus on the classical deficiency diseases beriberi and pellagra.

[The overheated lunch]. / Das hitzige Mittagessen.

We report about three patients consulting a general practitioner with acute onset of allergy-like clinical signs after having consumed tuna fish salad in the same restaurant. The treatment with antihistamines and steroids was effective and induced a quick regression of the symptoms. We look at considerations regarding the differential diagnosis and explain the pathophysiologic and the biochemical mechanisms of scombrotoxicosis.

Nous rapportons le cas de trois patients qui se présentent dans un cabinet médical souffrant de symptômes de type allergique après la consommation d'une salade de thon dans le même restaurant. Un traitement d'antihistaminiques et de stéroïdes s'est révélé efficace avec une rapide régression des symptômes. Nous proposons une réflexion sur le diagnostic différentiel et ses conséquences. En autre nous expliquons les mécanismes pathophysiologiques et biochimiques de la scombrotoxicose.