Abstract
A 66-year-old man with no history of drinking underwent proximal gastrectomy for gastric cancer 1 year prior to the first examination. Since difficulty in walking, myoclonus of the extremities, and delirium developed around February 2006 and gradually progressed, he was admitted to the Department of Neurology of our hospital for further evaluation, and referred to our department for the evaluation of skin eruptions that appeared on the dorsum of the hands from March 2006. Dermatological examination revealed reddish-brown, pruritic erythema and fissures, but no eruptions on the exposed areas of the skin.The characteristic skin eruptions and neurologic findings of myoclonus and delirium associated with diarrhea and macrocytic anemia led to the diagnosis of pellagra. Serum nicotinic acid levels were slightly decreased. The intravenous administration of 100 mg/day nicotinic acid amide markedly improved his symptoms, and enabled him to engage in everyday conversation within 2 weeks.
