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Pellagra in 2 Homeless Men

Source: www.mayoclinicproceedings.com
Topic: Pellagra
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Sort Desciption: Pellagra is a nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, ...

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Pellagra is a nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. Untreated, pellagra is fatal. Two cases of pellagra in contemporary homeless people are described. Complete evaluation supported a clinical diagnosis of pellagra after exclusion of other possibilities. Signs and symptoms resolved after institution of niacin therapy and change in diet. Appropriate suspicion for a diagnosis of pellagra requires attention to a combination of socioeconomic and behavioral risk factors for nutritional deficiency. The combination of homelessness, alcohol abuse, and failure to eat regularlyâ particularly, failure to make use of shelterbased meal programsâ may identify people at special risk in contemporary settings.

Pellagra, a disease primarily due to niacin deficiency, was epidemic in the United States before 1950. Although contemporary medical literature focuses on the history of its eradication, some reports suggest that pellagra continues to occur but remains underappreciated, resulting in delayed diagnosis. Two series from Japan describe 28 patients who died of undiagnosed pellagra and underscore the importance of identifying populations at special risk.

To my knowledge, no report to date has described pellagra in contemporary homeless people, despite the fact that the homeless are subject to relevant vulnerabilities of alcoholism, social dislocation, and irregular access to food. This article describes 2 cases of pellagra in this population.

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