Images in Clinical Medicine
Pellagra-like Dermatitis
N Engl J Med 2006; 354:1614April 13, 2006
- Article
Three months after undergoing Roux-en-Y bariatric surgery, a 32-year-old woman presented with glossitis, angular cheilitis, and an erythematous, desquamative dermatitis with a distribution indicative of photosensitivity causing a burning sensation on her arms and around her neck (Panel A). She reported a 45-kg (100-lb) weight loss during the past four months and no diarrhea or neurologic symptoms. Pellagra was suspected because of the classic appearance of Casal's necklace (i.e., erythema, hyperpigmentation, and scales around the neck) (Panel B). Laboratory studies were notable for a plasma pyridoxine level of 0.6 ng per milliliter (2.4 nmol per liter; normal range, 5 to 30 ng per milliliter [20 to 121 nmol per liter]), a serum zinc level of 42 μg per deciliter (6 μmol per liter; normal range, 60 to 150 μg per deciliter [9 to 23 μmol per liter]), and a serum niacin level of 2.27 ng per milliliter (18 nmol per liter; normal range, 0.5 to 15 ng per milliliter [4 to 122 nmol per liter]). A biopsy of skin from the left forearm revealed parakeratosis and some epidermal necrosis overlying a superficial perivascular and interstitial lymphocytic infiltrate. The diagnosis of a pellagra-like dermatitis was established. Classic cases of pellagra are associated with dermatitis, diarrhea, dementia, and if not treated, death. The use of sunscreen and supplements of pyridoxine, nicotinamide, zinc sulfate, and riboflavin resulted in marked improvement at the four-week follow-up.
Neda Ashourian, M.D.
Nico Mousdicas, M.D.
Indiana University, Indianapolis, IN 46202- Citing Articles (2)
Citing Articles
1
Erlend Tuseth Aasheim, Line Kristin Johnson, Dag Hofsø, Thomas Bøhmer, Jøran Hjelmesæth. (2011) Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study. Surgery for Obesity and Related Diseases
CrossRef2
Brooks Smith, Ashley Curtis, Amy Parsons, Gil Yosipovitch, Omar P Sangüeza. (2010) A 41-Year-Old Woman With a Scaly Erythematous Plaque Admixed With Erosions on the Groin, Back, and Legs: Answer. The American Journal of Dermatopathology 32:8, 850
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