Pellagra A forgotten sporadic clinical entity in primary health care

Abstract

A 45- year- old male from an urban community, laborer, heavy alcohol consumer, exclusively on rice diet presented to outpatient department in primary health care centre with chronic diarrhea for three months. He was treated multiple times with antibiotics with no improvement. There was no family history of similar illness. He had normal vital signs and mental state. On general examination, he had typical sharply marginated symmetrical scaly hyperpigmented plaques in sun exposed areas of his forearms and hands and necklace pattern of erythematous scaly plaque around the neck popularly known as Casal’s necklace as described in figure 1. The clinical background and dermatological pattern was sufficient enough to initiate treatment of pellagra with oral Niacin 300 mg daily and vitamin B complex. He had dramatic improvement in his episodes of diarrhea. He had gradual recovery in dermatitis.