View source for WBR1091

 {{WBRQuestion
|QuestionAuthor=Chetan Lokhande
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Dermatology, Gastrointestinal, Dermatology, Gastrointestinal, Preventive Medicine, Psychiatry, Biostatistics/ Epidemiology
|Prompt=A 42-year-old sailor from Panama comes the office with symptoms of diarrhea. On enquiry he says that he has a history of on and off diarrhea from the past 8 years. He states that his appetite has been decreased recently and the episodes of diarrhea are often associated with nausea and vomiting. On examination vitals are temperature of 99 F, pulse of 76/ minute and respiratory rate of 12/ minutes. On examination of the skin a rash is noticed on the extremities. This rash resembles likes a sunburn and burns when touched.  Abdominal examination and cardiovascular examination are insignificant.  On examination of the tongue it appears to be swollen and dark red in color resembling like ”beef’’. Neurological examination doesn’t reveal any focal neurological findings except for an irritable mood and poor memory and concentration. What is the most likely cause of his symptoms?
|Explanation=[[Pellagra]] is a vitamin deficiency disease most frequently caused by a chronic lack of niacin (vitamin B3) in the diet. It can be caused by decreased intake of [[niacin]] or [[tryptophan]], and possibly by excessive intake of [[leucine]]. It may also result from alterations in protein metabolism in disorders such as [[carcinoid syndrome]]. A deficiency of the amino acid lysine can lead to a deficiency of niacin, as well.
Pellagra is classically described by "the four Ds": [[diarrhea]], [[dermatitis]], [[dementia]] and death. A more comprehensive list of symptoms includes:
1.High sensitivity to sunlight
2.Aggression
3.[[Dermatitis]], [[alopecia]] (hair loss), edema (swelling)
4.Smooth, beefy red [[glossitis]] (tongue inflammation)
5.Red skin lesions
6.Insomnia
7.Weakness
8.Mental confusion
9.Ataxia (lack of coordination), paralysis of extremities, [[peripheral neuritis]] (nerve damage)
10.[[Diarrhea]]
11.[[Dilated cardiomyopathy]] (enlarged, weakened heart)
12.Eventually dementia

Untreated, the disease can kill within four or five years. Treatment is with nicotinamide, which has the same vitamin function as niacin and a similar chemical structure, but has lower toxicity. The frequency and amount of nicotinamide administered depends on the degree to which the condition has progressed.
|AnswerA=Vit B1 deficiency
|AnswerAExp=Vit B1 deficiency causes [[Beri-beri]] and also presents as [[Wernicke-Korsakoff]] syndrome. They present with [[ocular disturbances]], changes in mental state and unsteady stance and gait. It is also knows as wacky, wet and wobbly.
|AnswerB=Vit B2 deficiency
|AnswerBExp=Riboflavin deficiency is classically associated with the oral-ocular-genital syndrome. angular [[cheilitis]], [[photophobia]], and [[scrotal dermatitis]] are the classic remembered signs.
|AnswerC=Vit B3 deficiency
|AnswerCExp=Vit B3 (Niacin)  deficiency presents as [[Pellagra]] which is classically described by "the four Ds": [[diarrhea]], [[dermatitis]], [[dementia]] and death.
|AnswerD=Vit B6 deficiency
|AnswerDExp=The classic clinical syndrome for B6 deficiency is a seborrhoeic dermatitis-like eruption, atrophic [[glossitis]] with ulceration, angular [[cheilitis]], [[conjunctivitis]], intertrigo, and neurologic symptoms of [[somnolence]], [[confusion]], and [[neuropathy]].
|AnswerE=Vit B12 deficiency
|AnswerEExp=Vitamin B12 deficiency can lead to vitamin B12 deficiency anemia and neurologic dysfunction.  It may also cause easy bruising or bleeding, including bleeding gums. GI side effects including sore tongue, stomach upset, weight loss, and diarrhea or constipation. If the deficiency is not corrected, nerve cell damage can result. If this happens, vitamin B12 deficiency may result in tingling or numbness to the fingers and toes, difficulty walking, mood changes, [[depression]], memory loss, disorientation and, in severe cases, dementia.
|EducationalObjectives=Vit B3 (Niacin)  deficiency presents as [[Pellagra]] which is classically described by "the four Ds": [[diarrhea]], [[dermatitis]], [[dementia]] and death.
|RightAnswer=C
|WBRKeyword=Niacin deficiency, Pellagra
|Approved=Yes
}}