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Case Reports: Reminder of important clinical lesson
Pellagra as a differential diagnosis in the confused patient on the acute medical unit
  1. Jennifer Catherine Tew1,
  2. Laura Harrington2,
  3. Haythum Elsayed2 and
  4. Gideon Mlawa3,4
  1. 1Acute Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
  2. 2General Internal Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
  3. 3Diabetes and Endocrinology/General Internal Medicine, Queen’s Hospital Romford, London, UK
  4. 4Diabetes and Endocrinology/General Internal Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
  1. Correspondence to Dr Gideon Mlawa; gideon.mlawa{at}nhs.net

Abstract

A man in his 80s was admitted via the acute medical take after presenting with increased confusion and features of alcohol withdrawal. He had a several-month history of a worsening pruritic rash surrounding his neck, arms and legs in addition to new, profuse diarrhoea. In view of the background of known chronic alcoholism and the coexisting symptoms of rash, confusion and diarrhoea, pellagra was diagnosed via a multidisciplinary approach. Oral nicotinamide supplementation was commenced and his symptoms responded rapidly. The bias and challenge of reaching a unified diagnosis in the context of a multisystem condition are exemplified in this case report.

  • dermatology
  • alcohol-related disorders
  • medical education
  • malabsorption

https://doi.org/10.1136/bcr-2022-249405

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    Footnotes

    • Contributors JCT, LH, HE and GM contributed equally to the writing of this case report. The information included was up to date at the time of publishing. The case report was submitted for publication with the patient's consent and knowledge.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.