Pellagra Associated with Chronic Alcoholism : A Case Report

Abstract

A 39-year-old female became a habitual drinker 5 years ago. For the last 6 months, the amount of her alcohol intake has been about 1l of SAKE a day, which resulted in an unbalanced diet and the subsequent weight loss and amenorrhea. In August, 1980, symmetrical erythemas appeared on the limbs as well as lancinating pain in the legs. On withdrawal from alcohol, she suffered from temporary delirium and frequent diarrhea, and was admitted to our hospital. At the time of admission, weakening of the tendon reflexes, peripheral hypesthesia, and ataxia in walking were apparent in addition to the erythema and diarrhea. Alcoholic beverages were completely stopped and oral intake of food was increased little by little. Vitamines were also administered and her condition improved rapidly. The symptoms, which included delirium, polyneuropathy, symmetrical erythemas on the limbs and diarrhea. were diagnosed as pellagra associated with chronic alcoholism. This condition can be regarded as polyhypovitaminosis based on chronic alcoholism. Pellagra, a nicotinic acid deficiency disease, is rarely observed clinically nowadays. Present case revealed that various factors such as an absolute lack of Tryptophan intake, malabsorption caused by drinking, and metabolic dysfunction, when concurrent, can precipitate pellagra. The long habit of drinking and almost self-destructive dietary practice are obviously the direct cause and it is also inferred that some sort of disorder in matabolism must have existed as well.