The 3 D's of Pellagra: Diarrhea, dermatits, dementa (and death)

He presents with the classic triad of symptoms for pellagra, vitamin B3/niacin deficiency. (FA2020 p67)

• This is not beriberi (B1/thiamine deficiency) - Beriberi may present with polyneuropathy and muscle wasting but not skin findings or diarrhea. Wet beriberi may also present with heart failure/cardiomyopathy. (FA2020 p66)
• Scurvy (C/ascorbic acid deficiency) presents with swollen gums, easy bruising, petichiae, corkscrew hairs, and weakened immune response (FA2020 p69)
• Wernicke syndrome (B1/thiamine) presents with confusion, ophthalmoplegia, and ataxia and is associated with chronic alcoholism. May progress to Korsakoff syndrome which is severe amnesitic disorder, confabulation, and personality change (p66)
• Whipple disease is caused by the bacteria Trophyrema whippili and is characterized by foamy PAS+ macrophages in the intestinal lamina propria, malabsorption, cardiac symptoms, arthralgias, and neuro symptoms are common (p381)