Metrics details. Alcohol withdrawal delirium AWD is associated with significant morbidity and mortality. Pellagra niacin deficiency can be a cause of delirium during alcohol withdrawal that may often be overlooked. We present a three-patient case series of pellagrous encephalopathy delirium due to pellagra presenting as AWD. We conclude by providing a review of existing guidelines on the management of alcohol withdrawal, highlighting that they do not include pellagrous encephalopathy in the differential diagnosis for AWD.
Pellagra is a disease caused by a lack of the vitamin niacin vitamin B 3. There are two main types of pellagra, primary and secondary. Treatment is with either niacin or nicotinamide supplementation. The classic symptoms of pellagra are diarrhea , dermatitis , dementia , and death "the four Ds". Frostig and Tom Spies —according to Cleary and Cleary  described more specific psychological symptoms of pellagra as:.
[Pellagra: a clinical, histopathological, and epidemiological study of 7 cases]
Pellagra was first identified among Spanish peasants by Don Gaspar Casal in In it was discovered that pellagra was caused by a deficiency of the B vitamin niacin nicotinic acid. Two decades before the discovery of niacin, however, epidemiological and clinical research done by Joseph Goldberger and his colleagues had identified that pellagra could be prevented by improved diet. By , the state of South Carolina alone had reported 30, cases of pellagra, with a case fatality rate of 40 per cent. The disease was not confined to Southern states, however, and the US Congress asked the Surgeon General to investigate the disease.
Pellagra is a disease due to the lack of niacin. Niacin is part of the vitamin B family. Symptoms of this disease include inflamed skin, sores, and insanity.