Subclinical Pellagra: Its Diagnosis and Treatment

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Definition: Subclinical pellagra is a deficiency syndrome characterized by the presence of perceptual changes, affecting any or all of the five senses, associated with neurasthenia. It is due to the deficiency of, or an increased demand for, niacin; the administration of which causes prompt disappearance of the symptom complex.

All doctors have patients who do not seem to measure up to expectations. The child does not do well in school or finds it more difficult than before. With present day report cards, not even the teacher will tell how a child is doing, but the child has a good idea. The mother will mention the child is not normal, will lie down after school, is cranky, easily upset and tired. Adult patients find it hard to do their work, they feel and are miserable.

They complain of fatigue, malaise, headache or any sort of pain—seemingly to get attention. If in physical examinations we do find injected pharangeal lymphoid tissue, or diagnose a mesenteric adenitis, we are happy and so are the patients but for the time being only. The patients will return with the same or other complaints in spite of the most careful explanation of their ills.

X-rays and laboratory tests show nothing abnormal, still the patients complain. For the past 20 years I have been diagnosing them as neurotic, having flu, neurasthenia, sore throat, backache, etc., etc., for want of something better. It is certainly true that patients have suffered perceptual changes in the past 20 years.