Volume 35, Issue 5 p. 860-863
Clinical Observations

Pellagra, an Almost-Forgotten Differential Diagnosis of Chronic Diarrhea: More Prevalent Than We Think

Shanjin Cao MD, PhD

Corresponding Author

Shanjin Cao MD, PhD

Department of Hospitalist, Charlton Memorial Hospital, Fall River, MA, USA

Department of Hospitalist, Prima CARE, P.C., Fall River, MA, USA

Corresponding Author:

Dr. Shanjin Cao, MD, PhD, Department of Hospitalist, Prima CARE, P.C., Fall River, MD 02721, USA.

Email: [email protected]

Search for more papers by this author
Xiaodan Wang MD

Xiaodan Wang MD

Department of Hospitalist, Charlton Memorial Hospital, Fall River, MA, USA

Department of Hospitalist, Prima CARE, P.C., Fall River, MA, USA

Search for more papers by this author
Kristen Cestodio NP

Kristen Cestodio NP

Department of Hospitalist, Charlton Memorial Hospital, Fall River, MA, USA

Department of Hospitalist, Prima CARE, P.C., Fall River, MA, USA

Search for more papers by this author
First published: 09 October 2019
Citations: 13

Financial disclosure: None declared.

Conflicts of interest: None declared.

Abstract

Pellagra, caused by vitamin B3 (niacin) deficiency, is traditionally described as dermatitis, diarrhea, dementia (3D), and even death (4D) syndrome if not recognized and treated promptly. Although full-blown pellagra with all 3D features has become rare, pellagra still exists, especially in high-risk populations, which is actually more prevalent than we think. We report that a recently treated patient with the full spectrum of 3D clinical features of pellagra presents as chronic diarrhea of unknown etiology for 1 year. It reminds us that keeping a high index of suspicion and maintaining a broad differential diagnosis are critical for recognition and management of this potentially fatal but treatable condition.