Question based short case presentation

1. Case study
By rohit Kumar saini
1ST year student

2. A 35-year-old poor farmer on irregular diet presents
with history of frequent diarrhea and dry scaly
lesions around the neck for past 2 months. On
examination, he was found to have characteristic
lesions around the neck and dorsum of hand.
Lesions were itchy specially on exposure to sun. He
grows maize and gives the history of excess maize
consumption for past 10 years.

3. Q1 What is the diagnosis of the above case

4. Q1 What is the diagnosis of the above case
Ans:-This patient is suffering with pellagra
(pelle: skin; agra: sour), a disease which is due
to deficiency of vitamin B3 (niacin or nicotinic
acid).
This disease is characterized by 3 Ds:
Diarrhea, dermatitis and dementia.

5. Q2 What is the name given to this
characteristic lesion observed around the neck
and on hand of the individual?

6. Q2 What is the name given to this
characteristic lesion observed around the neck and
on hand of the individual?
Ans:-Skin shows characteristic lesion around neck
named Casal's necklace deformityand dry scaly
lesions on hand known as gloved hand dermatitis.

8. Q.3. Which amino acid may synthesize nicotinic
acid in vivo in cell?

9. Q.3. Which amino acid may synthesize nicotinic
acid in vivo in cell?
Tryptophan is amino acid which may produce
nicotinic acid in a vitamin B requiring pathway
known as kynurenine pathway. Tryptophan is
abundantly found in legumes, fish and meat.

10. Q.4. Q.4. Is the dependency of maize as staple diet may be a cause of
this presentation? If yes,then why?

11. Q.4. Is the dependency of maize as staple diet may be a cause of
this presentation? If yes,
then why?
Yes it may be! Maize has low content of tryptophan, so the
synthesis of niacin from tryptophan is deficient. On the other hand,
the content of niacin is though high in maize, it is found in bound
form "Niacytin", hence not available for absorption
Similarly, another cereal which is associated with pellagra when
consumed as staple diet is jowar. Jowar has rich amount of L-
leucine which interferes with kynurenine pathway and hence
reduces production of nicotinic acid from tryptophan. This is known
as "Leucine pellagra".

12. Q.5. Enlist the causes/conditions when patient
may have pellagra or pellagra-like features.

13. Q.5. Enlist the causes/conditions when patient
may have pellagra or pellagra-like features.
Niacin deficiency
Excess corn consumption
Hartnup disease
Serotonin secretary tumor(carcinoid tumor)

14. Q.6. What is the treatment of this disease?

15. Q.6. What is the treatment of this disease?
Ans.6. Treatment of this disease is oral
supplementation of vitamin B3, in the dose 30
mg twice daily.

16. Thank you