Pellagra encephalopathy without dermatological manifestations in an alcoholic patient post vitamin B1 and B12 treatment

Abstract

This case report details pellagra encephalopathy without dermatological symptoms in a 43-year-old female patient with a history of alcohol misuse, who was undergoing treatment for vitamin deficiency neuropathy with vitamin B1 and B12 supplements. The patient's condition associated with excessive alcohol consumption triggered by interpersonal and work-related stress was diagnosed as vitamin deficiency neuropathy. She was prescribed vitamins B1 and B12 for approximately one year. In the months preceding her hospital admission, she experienced gastrointestinal distress and speech difficulties, escalating to delusions, hallucinations, disorientation, and gait disturbances a day prior to hospitalization. Treatment with a multivitamin regimen, including nicotinamide, resulted in rapid amelioration of her gastrointestinal issues and consciousness level; however, specific neurological and cognitive impairments persisted. Her serum niacin level was measured at 3.3 µg/ml, confirming a diagnosis of pellagra encephalopathy, despite the absence of dermatological manifestations. It has been pointed out that pellagra associated with alcohol dependence often presents without skin symptoms, requiring careful attention to ensure it is not overlooked during alcoholism treatment.