Case study
49 years old male, admitted with history of hyperpigmented elevated rash all over body predominately on trunck, back, cervical area, limbs 3 months duration. History of memory disturbances 1 month duration. History of Unsteadiness gait since 15 days duration. No History of similar iilness in the past. On patient Awake, Lethergic , CVS – S1 S2+, RS- BAE+, CNS – gait Ataxia +, Romberg’ s test positive, Stance Ataxia.
Dermatologist, Neurophysician, General Physician opinion obtained. Patient was Started Niacin Supplement 100mg three times/ Day and other vitamin, thiamine Supplements. Patient Conditioned improved Clinically .
Investigations Vitamin B12, S.Copper levels were within normal limits. USG abdomen with CT Abdomen revealed no evidence of internal tumors (To rule out Carcinoid Syndrome )Niacin level in serum report awaited.
Niacin is an essential nutrient involved in synthesis , metabolism of carbohydrates, protein & fatty acids. Niacin deficiency causes pellegra. Which is characterized by photosensitive pigmented dermatitis, dementia and may progress to death.
Discussion
It is more common in the people who obtain most of there food energy from maize. If maize is not NIXTAMALIZED (preserved). It is a poor source of tryptophan.
Deficiency of tryptophan (an essential amino acids in meat, fish, eggs, peanuts) that body converts into niacin
Malabsorption Syndrome – prevent absorption of dietary niacin or tryptophan
Example : Crohn’s disease, Gastroenterostomy
Chronic Alcoholism also cause poor absorption dietary niacin.
Hastnup disease a genetic disorder reduces trptophan absorption.
Carcinoid Syndrome, neuroendocrine tumor , use tryptophan for excessive serotinin production which limits available for niacin synthesis.
CLINICAL DIAGNOSIS
- serum niacin levels
- 24 hours urine 5HIAA. To rule out carcinoid tumor
- Contrast enhanced CT abdomen to rule out Carcinoid tumor
- TREATMENT: NIACIN supplement 100 mg thrice a day
Aakash Team