Dementia associated with Pellagra: A rare case report
Notice bibliographique
Résumé
Dementia is a neuropsychiatric illness characterized by progressive cognitive impairment in clear consciousness. It has varied etiologies, with neurodegenerative conditions being most common causes.[1] By timely diagnosis and intervention, symptoms of dementia may be reversed or brought to minimal impairment. These groups of dementia are often labeled as ‘Reversible dementias’[2] A 55-year-old married female, mother to two children, educated up to 8th standard, of middle S.E. status and rural background, was admitted to the psychiatry ward with symptoms characterized by agitation, disorientation, hallucinatory behavior, crying spells, ataxic gait, slurred speech, minimal self-care, altered sleep, and appetite. No history of substance use and restrictive dietary patterns was reported. On clinical examination, vitals were normal. Neurological examination showed 4/5 power in four limbs. On MSE, she was unkempt and had perplexed affect, visual hallucinations, and impaired attention and memory. Lobar function tests showed deficits in frontal and temporal lobes. In the frontal lobe, deficits were seen in set shifting, go-no-go test, graphic luria, and verbal fluency tests. In the temporal lobe, both verbal and visual memories were impaired. Montreal Organic Cognitive Assessment (MOCA) showed 6/30 with impairment in visuospatial/executive domain, naming, attention, language and abstraction. Mini mental status examination (MMSE) revealed 8/30 scores with deficits in visuospatial, concentration, language, and memory domains. On GPE, she had hyperpigmented macules in B/L hands. Dermatological C/L was taken, and clinical diagnosis of pellagra was made. Laboratory investigations showed low hemoglobin (9 g/dl), MCV (62.6 FL), MCH (18.1 pg), and slightly elevated ESR (50 mm/hr) and qCRP (40.6 mg/L). Serum folate levels and vitamin D and B12 levels were normal. MRI brain was insignificant. Duodenal biopsy revealed partial villous atrophy. Celiac disease was ruled out by the absence of the tissue transglutaminase (tTG) IgA antibody. Based on above findings, the diagnosis of organic dementia (F02.8) and pellagra (E52) was made. Although serologic and urinary assays for supporting the diagnosis were not available in our hospital, treatment with nicotinamide 300 mg per day orally in divided doses was started. The skin lesions improved significantly along with other objective meausures (MMSE 23/30 and MOCA 21/30 after 7 days, MMSE 26/30 and MOCA 24/30 after 3 weeks). Currently, the patient is under regular follow-up and is maintaining well in all sets of symptoms. All psychotropics were tapered off gradually. Pellagra is a rare nutritional deficiency with only sporadic cases occurring due to varied etiologies including malnutrition, G.I. tract diseases, malignancies, alcohol use, drugs (e.g., isoniazid), and carcinoid syndrome. Diagnosis of pellagra remains clinical, with characteristic skin lesions as pathognomic.[3] Neuropsychiatric manifestations can occur even without skin manifestations. The symptoms vary from lethargy, depression, anxiety, poor concentration, irritability to disorientation, confusion, and delirium. Eventually, the patient may become stuporous and comatose. Death may occur if left untreated.[4] In the index case, initial neuropsychiatric symptoms mimicked depression, and later, forgetfulness, cognitive decline, delirium, hallucinatory behavior led to diagnosis of dementia. With administration of niacin, dementia and dermatitis usually improve significantly within the first week of therapy. This case highlights need of comprehensive assessment and evaluation of every finding in context to reversible etiologies of dementia. Patient consent Duly signed patient consent was taken after explaining about the case report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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