Pellagrous encephalopathy and alcohol withdrawal delirium: A case report

Chronic alcohol consumption is a common etiology, for pellagra is frequently under-diagnosed and thus not adequately treated. A 30-year-old gentleman presented with a history of consumption of alcohol in a dependence pattern for the previous 10 years with altered sensorium and hallucinatory behavior for 3 days. He exhibited skin lesions over sun-exposed regions of both the upper and lower extremities. He was diagnosed to have complicated alcohol withdrawal syndrome and alcoholic pellagra. He was treated with oral diazepam and multivitamins containing thiamine and niacin. The patient's behavioral problems and skin lesion improved gradually. Pellagrous encephalopathy was most likely a contributing cause of behavioral abnormalities and altered sensorium in our case and it could be recognized due to the presence of the typical rash. Pellagrous encephalopathy may manifest even without skin lesion. Niacin supplementation along with standard thiamine therapy is recommended in all cases of altered sensorium in heavy alcohol users.