Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

被引：29
作者：
Oldham M.A. [1 ]
Ivkovic A. [1 ]
机构：
[1] Boston University Medical Center, 850 Harrison Ave., Dowling 7S, Boston, 02118, MA
来源：
Addiction Science & Clinical Practice | / 7卷 / 1期
关键词：
Alcohol withdrawal delirium; Delirium tremens; Niacin deficiency; Pellagra; Pellagrous encephalopathy; Vitamin B3 deficiency;
D O I：
10.1186/1940-0640-7-12
中图分类号：
学科分类号：
摘要：
Background: 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. Objectives: We present a three-patient case series of pellagrous encephalopathy (delirium due to pellagra) presenting as AWD. Methods: We provide a brief review of pellagra's history, data on pellagra's epidemiology, and discuss pellagra's various manifestations, particularly as related to alcohol withdrawal. 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. Results: Though pellagra has been historically described as the triad of dementia, dermatitis, and diarrhea, it seldom presents with all three findings. The neurocognitive disturbance associated with pellagra is better characterized by delirium rather than dementia, and pellagra may present as an isolated delirium without any other aspects of the triad. Discussion: Although endemic pellagra is virtually eradicated in Western countries, it continues to present as pellagrous encephalopathy in patients with risk factors for malnutrition such as chronic alcohol intake, homelessness, or AIDS. It may often be mistaken for AWD. Whenever pellagra is suspected, treatment with oral nicotinamide (100 mg three times daily for 3-4 weeks) prior to laboratory confirmation is recommended as an inexpensive, safe, and potentially life-saving intervention. © 2012 Oldham and Ivkovic; licensee BioMed Central Ltd.
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  • [1] Hack J.B., Hoffman R.S., Nelson L.S., Resistant alcohol withdrawal: Does an unexpectedly large sedative requirement identify these patients early?, J Med Toxic, 2, 2, pp. 55-60, (2006)
  • [2] Khan A., Levy P., Dehorn S., Miller W., Compton S., Predictors of mortality in patients with delirium tremens, Acad Emerg Med, 15, 8, pp. 788-790, (2008)
  • [3] Kahn D.R., Barnhorst A.V., Bourgeois J.A., A case of alcohol withdrawal requiring 1,600 mg of lorazepam in 24 hours, CNS Spectr, 14, 7, pp. 385-389, (2009)
  • [4] McCowan C., Marik P., Refractory delirium tremens treated with propofol: A case series, Crit Care Med, 28, 6, pp. 1781-1784, (2000)
  • [5] Dastur D.K., Santhadevi N., Quadros E.V., Avari F.C., Wadia N.H., Desai M.N., Bharucha E.P., The B-vitamins in malnutrition with alcoholism. A model of intervitamin relationships, Br J Nutr, 36, 2, pp. 143-159, (1976)
  • [6] David A.S., Fleminger S., Kopelman M.D., Lovestone S., Mellers J.D.C., Lishman's Organic Psychiatry: A Textbook of Neuropsychiatry, (2009)
  • [7] Russell R.M., Suter P.M., Vitamin and trace mineral deficiency and excess, Harrison's Principles of Internal Medicine, (2012)
  • [8] Cook C.C.H., Hallwood P.M., Thomson A.D., B vitamin deficiency and neuropsychiatric syndromes in alcohol misuse, Alcohol Alcohol, 33, 4, pp. 317-336, (1998)
  • [9] Ishii N., Nishihara Y., Pellagra among chronic alcoholics: Clinical and pathological study of 20 necropsy cases, J Neurol Neurosurg Psychiatry, 44, pp. 209-215, (1981)
  • [10] Serdaru M., Hausser-Hauw C., Laplane D., Buge A., Castaigne P., Goulon M., Lhermitte F., Hauw J.J., The clinical spectrum of alcoholic pellagra encephalopathy. A retrospective analysis of 22 cases studied pathologically, Brain, 111, pp. 829-842, (1988)
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