S2851 Pellagra (Niacin – Vitamin B3 Deficiency) as a Cause of Chronic Diarrhea in a Patient With Soap Ingestion

INTRODUCTION: Pellagra is a clinical syndrome caused by the deficiency of Niacin (Vitamin B3). Deficiency can be caused by the decreased intake in diet, alcoholism, and abnormalities with absorption in the gastrointestinal tract. The most characteristic finding of Pellagra is the presence of asymmetric hyperpigmented rash, similar in color. Other clinical findings are a red tongue and many nonspecific symptoms, such as diarrhea and vomiting and neurological problems including dementia. CASE DESCRIPTION/METHODS: A 45-year-old woman with a history of latent syphilis, hypothyroidism, iron deficiency anemia, alcohol abuse, bipolar disorder presented with complaints of exertional shortness of breath, palpitations, along with watery diarrhea for three weeks. Further history obtained from the mother revealed that the patient has been eating microwaved soap for a long period. Examination on arrival showed glossitis, thrush, and desquamating rash on the abdomen/breast with erythematous papules on extremities. Labs showed a hemoglobin level of 5.8 g/dL, WBC 31.1 k/uL, zinc level of 46 mcg, and niacin level of < 20 ng/ml. Biopsy of skin lesions was done which showed psoriasiform dermatitis. EGD showed diffuse moderate inflammation characterized by erythema in the gastric antrum and a widely patent and non-obstructing Schatzki ring at the gastroesophageal junction. The patient was started on Niacin supplementation and the symptoms improved remarkably. DISCUSSION: It is very important to note that the presentation of chronic diarrhea can be confused with many other disorders including nutritional deficiencies, chronic infections, and gastrointestinal disorders. As seen in this patient, detailed history obtained from the other sources including mother revealed that the patient has been ingesting toxic substances like soap which led to the decreased absorption of essential nutrients and vitamins in the gastrointestinal tract and detailed examination of the patient led to the diagnosis. In this patient, supplementation with niacin led to the improvement of diarrhea remarkably and also improvement of mental status and skin lesions over time.