Yogi Tek N, B C Pooja, Bhusal Amrit, Limbu Suren, Kafle Rijan
Department of Internal Medicine.
Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal.
Ann Med Surg (Lond). 2023 Nov 7;86(1):501-506. doi: 10.1097/MS9.0000000000001497. eCollection 2024 Jan.
Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological presentation of pellagra in a long-term alcohol and substance abuser, emphasizing the diagnostic challenges in resource-constrained settings.
A 36-year-old male with a history of substance abuse presented with multiple symptoms, including hallucinations and neurological deficits. His complex clinical history included alcohol dependence, seizures, and relapses. Physical and neurological examinations revealed characteristic signs of pellagrous encephalopathy. Laboratory findings confirmed anemia and a fatty liver.
Alcoholic pellagrous encephalopathy (APE) presents a diagnostic challenge due to its atypical symptoms, overlapping with other alcohol-related disorders. Niacin deficiency, central to its pathogenesis, affects neurotransmitter synthesis, contributing to neurological symptoms. Diagnosis relies on clinical presentation, but laboratory tests for niacin levels can aid in confirmation. Neuroimaging can exclude alternative causes. This case underscores the importance of considering pellagrous encephalopathy in alcohol-related disorders with neurological symptoms.
This case underscores the importance of recognizing atypical presentations of APE in chronic alcohol-dependent individuals. Prompt diagnosis, nutritional correction, and addressing alcohol use are vital for successful management. Healthcare providers must be aware of the diagnostic complexities and socioeconomic barriers hindering timely intervention in APE.
酒精使用障碍是一个全球性的健康问题，会引发多种并发症，包括糙皮病，由于其罕见性，糙皮病常常被忽视。本病例探讨了一名长期酗酒和滥用药物者糙皮病的神经学表现，强调了在资源有限的环境中诊断所面临的挑战。
一名有药物滥用史的36岁男性出现了多种症状，包括幻觉和神经功能缺损。他复杂的临床病史包括酒精依赖、癫痫发作和复发。体格检查和神经学检查发现了糙皮性脑病的典型体征。实验室检查结果证实存在贫血和脂肪肝。
酒精性糙皮性脑病（APE）因其非典型症状与其他酒精相关疾病重叠而带来诊断挑战。烟酸缺乏是其发病机制的核心，影响神经递质合成，导致神经症状。诊断依赖于临床表现，但烟酸水平的实验室检测有助于确诊。神经影像学检查可排除其他病因。本病例强调了在伴有神经症状的酒精相关疾病中考虑糙皮性脑病的重要性。
本病例强调了认识慢性酒精依赖个体中APE非典型表现的重要性。及时诊断、营养纠正和解决酒精使用问题对于成功治疗至关重要。医疗保健提供者必须意识到诊断的复杂性以及阻碍对APE及时干预的社会经济障碍。
