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Wernicke encephalopathy and pellagra in an alcoholic and malnourished patient
  1. Norihiko Terada1,
  2. Kensuke Kinoshita1,
  3. Shijima Taguchi1,
  4. Yasuharu Tokuda2
  1. 1Mito Kyodo General Hospital, Mito, Ibaraki, Japan
  2. 2Department of General Internal Medicine, Tsukuba University, Mito, Ibaraki, Japan
  1. Correspondence to Professor Yasuharu Tokuda, yasuharu.tokuda{at}


Deficiency of multiple vitamins can be identified in alcoholic and malnourished patients. We report a patient with Wernicke encephalopathy, a B1 deficiency and pellagra, a niacin deficiency. A 61-year-old Japanese man presented with generalised weakness. He had drunk alcohol heavily for more than a year without eating adequate meals. Physical examination showed disorientation, eye movement impairment, muscle wasting and a rash over the limbs. Multivitamin supplementations improved all the symptoms. Pellagra causes dementia, diarrhoea, or dermatitis, and can mimic non-specific erythaema in alcoholics. The differential diagnosis between pellagra and non-specific erythaema is important because of the treatability of pellagra by niacin supplementation.

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