1/8. Studies of tryptophan and albumin metabolism in a patient with carcinoid syndrome, pellagra, and hypoproteinemia.Detailed studies of protein metabolism were undertaken in a patient with pellagra and hypoproteinemia associated with the carcinoid syndrome both before and after treatment. The synthesis of albumin improved from 82 mg per kg per day to 135 mg per kg per day with little change in the daily excretion of 5-hydroxyindole acetic acid. After treatment with nicotinamide the patient made good progress with a complete resolution of the signs of pellagra and protein malnutrition. These results support the hypothesis that a reduced availability of the essential amino acid L-tryptophan may limit the synthesis of albumin and nicotinic acid in patients with the carcinoid syndrome who become anoretic.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/8. pellagra encephalopathy following B-complex vitamin treatment without niacin.pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/8. pellagra: a rare disease observed in a victim of mental and physical abuse.Lesions of the brain stem and cerebellum due to nutritional deficiencies are mostly seen in chronic alcohol abuse and more rarely in severe malnutrition. We report the case of a 27-year-old woman, found dead in the family flat. She presented cachexia (167 cm, 25 kg) and multiple hematomas of the limbs. Postmortem examination revealed lesions due to peritonitis. Neuropathological examination showed severe atrophy of the corpus callosum and central neuronal chromatolysis, which are observed in pellagra. Inflammatory colitis or celiac disease was not found. Toxicological analysis was negative, in particular no alcohol absorption. pellagra, which is due to nicotinamide deficiency, is a disease rarely seen in this country. In this case, nutritional deficiency was the consequence of failure to eat in a context of abuse. The woman was born of an incestuous relationship and presented intellectual retardation due to poor affective relations with her mother.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
4/8. Nutritional deficiencies and the skin.malnutrition states are relatively uncommon in the UK but we have seen two recent cases which have heightened our awareness of both dermatological manifestations of malnutrition and of nutritional sequelae of a dermatological problem. Case 1 is a patient with anorexia nervosa presenting with features of pellagra. This condition is due to deficiency of niacin and responds rapidly to replacement therapy. Classical presentation is an erythematous rash on photoexposed sites, often related to heat or friction. There are three reported cases of pellagra occurring in patients with anorexia nervosa. Case 2 is an adult atopic with sensitizations to multiple foodstuffs. A self-imposed restriction diet caused multiple nutritional deficiencies. Restriction diets in adult atopics are not particularly common in the UK, but there is some evidence to suggest that they may cause significant nutritional deficiency. A nutrition screen may be indicated more frequently than is currently recognized.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
5/8. Elevated glutamic acid values in a malnourished patient. A case report.Routine serum and cerebrospinal (CSF) amino acid estimations were carried out on a patient with pellagra and malnutrition. urea levels were low and serum and CSF ammonia levels elevated. A remarkable observation was that the serum glutamic acid level rose to 44.9 times normal, which is far higher than any value reported in the medical literature. At this stage no explanation for this rise is known. Similarly no explanation can be given for the posttreatment elevation of the CSF proline levels to 13.8 times above normal.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
6/8. pellagra: unusual cause of paranoid delirium in dialysis.A 60-year-old woman treated by maintenance haemodialysis refused to take part of the usual vitamin supplements for many years. After an intercurrent illness with profound malnutrition, she developed a paranoid delirium and some behavioural disorders; concomitant diarrhoea and a skin rash were noted. Parenteral nicotinamide (500 mg/day) resulted in a complete recovery from the mental disorders after five days. Other causes of mental disturbance as a result of dialysis could be ruled out. However an asymptomatic underlying hypothyroidism may have been one of the conditioning factors as well as the failure to administer nicotinamide supplements during an acute illness. Neurological pellagra could thus be considered as a rare but reversible cause of mental disorders in patients on maintenance haemodialysis.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
7/8. Crohn's disease associated with pellagra and increased excretion of 5-hydroxyindolacetic acid.A 47-year-old woman with seronegative polyarthritis, diarrhea, and photosensitivity dermatitis was found to have Crohn's disease and pellagra. The presence of high values of 5-hydroxyindolacetic acid in the urine began the exhaustive investigations and finally enterotomy. No mass lesion was found. Argyrophilic cells were not increased in areas of inflamed intestinal mucosa or the normal mucosa. The disagreement between biochemical and histologic findings was attributed to sampling error. Antiinflammatory treatment for Crohn's disease was given and the gastrointestinal and articular symptoms improved, excretion of 5-hydroxyindolacetic acid returned to normal and there was no relapse of pellagra. pellagra as a complication of Crohn's disease has been described in 4 cases; malnutrition and intestinal malabsorption were the proposed mechanisms for the niacin deficiency and pellagra of those patients. In the current case, the pathogenesis of pellagra may be accounted to wastage of tryptophan by an increased pool of intestinal argyrophilic cells, suggested by increased urinary excretion of 5-hydroxyindolacetic acid.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
8/8. pellagra.pellagra due to malnutrition occurred in an Ottawa women in 1973. She was given a normal diet with supplements of riboflavin, thiamine, niacin and ascorbic acid. The clinical response was striking. Although pellagra is still common in some parts of the world, it is now rare in north america. The disease may occur secondary to malnutrition or malabsorption; inborn errors of metabolism or transport, as in hartnup disease; deviation of precursors of niacin, as in carcinoid syndrome; or competitive inhibition of niacin incorporation into nicotinamide-adenine dinucleotide, as with administration of isoniazid.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |