Opšta Medicina (Jan 2020)
Pellagra associated reversible dementia
Abstract
Introduction: Celiac disease is a consequence of certain hereditary predisposition resulting in permanent gluten intolerance. Gluten is a protein found in wheat, barley, rye, and oats. First lesions appear in the mucose of the proximal part of the small intestine. This leads to the decreased absorption of nutrients and consequential nutrition deficit. Niacin and tryptophan absorption is decreased which is one of the reasons for pellagra occurrence. The symptoms of pellagra are dermatitis, diarrhea, and dementia. If not treated it may cause disorientation, confusion, delirium, and ultimately death. Case report: Female patient, 33, works in a shoe factory, mother of two, presents with her mother. Her mother noticed she has become disinterested, forgetful, moody, silent with no initiative. She suffers from celiac disease since childhood and she`s been using cornbread for years. Since a month ago she started noticing skin lesions and frequent diarrheas. The main reason for her visit is that she got very scared the day before because she couldn't remember how to find her way home. Due to her basic condition, she was diagnosed with pellagra induced dementia, due to the B vitamin deficienecy (B1, B2, B3, B6, B12). Followed by an intensive vitamin therapy and adequate nutrition, recommended by a nutritionist, dementia symptoms withdrew. Conclusion: A patient`s history with a typical clinical presentation is good enough to suspect pellagra. Knowing that celiac disease is the reason the patient was using cornbread (which lacks vitamin B) and at the same time, the patient was experiencing diarrheas are good enough reasons to suspect pellagra. The treatment of celiac disease should include consultations of a gastroenterologist and nutritionist. Should there be any other disease complications a dermatologist, infectologist, neurologist, and psychiatrist should be consulted.
