vitamin B complex deficiency"Pellagra"

Pellagra

 

Definition and Aetiology:

This is a multiple deficiency disease due to vitamin B complex deficiency specially niacin;
this may result from:

• Deficient intake of vitamin B or of proteins of high biological value (containing nicotinic acid or its precursor tryptophan).
• Deficient absorption as in gastro-enteritis.
• Parasitic infestation.

Clinical picture:

1)Cutaneous manifestations:

• They start as a bilateral and symmetrical dermatitis followed by hyperkeratosis(rough, scaly and desquamated skin) and pigmentation.

• The lesions involve the exposed areas(face, neck, dorsum of the hands and feet) and over bony prominences(trochanters, elbows, knees, heels)

 

2)Gastro-intestinal manifestations:

• Mouth: stomatitis, glossitis with atrophy of the papillae(glazed tongue).

• Stomach: dyspepsia, nausia, vomiting, epigastric pain.
• Intestines: colic, diarrhoea.
• Hepato-splenomegaly may be present.

3)Neuropsychiatric manifestations:

• Peripheral neuropathy mainly sensory due to peripheral nerves degeneration.
• Paraplegia or quadriplegia(systemic paraplegia) due to pyramidal tract degeneration(pellagral lateral sclerosis).
• Mentality changes as anterograde amnesia, depression, dementia and suicidal tendencies due to cerebral cortex degeneration.

Treatment:

1. Treatment of the cause e.g. parasitic infestation or gastro-enteritis.
2. Good diet, rich in animal proteins and vitamins.
3. Vitamin B complex(the cheapest source is yeast) iron supplement(to correct anaemia).
4. Nicotinamide 500 mg I.V. daily in severe cases, followed after improvement by 200 mg daily I.V. for 2 weeks; maintenance dose 100 mg t.d.s. orally.