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| CASE REPORT |
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| Year : 2020 |
Volume
: 31 | Issue : 4 | Page
: 874-876 |
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Pellagra Disease in a Hemodialysis Patient
Sana Barrah1, Hela Jebali1, Rania Kheder1, Madiha Krid1, Wided Smaoui1, Soumaya Beji1, Fathi Ben Hmida2, Lilia Ben Fatma1, Lamia Rais1, Mohamed Karim Zouaghi1
1 Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis, Tunisia
2 Department of Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital; Department of Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
Correspondence Address:
Sana Barrah
Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis
Tunisia
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DOI: 10.4103/1319-2442.292325 PMID: 32801252 
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Pellagra usually results from niacin deficiency and presents with the classic triad of dermatitis, diarrhea, and dementia. It is most commonly associated with malnutrition and poverty. We report a case of pellagra in a hemodialysis (HD) patient with breast neoplasia, aged 68-years, female, on HD unit for seven years. Her original nephropathy was indeterminate. The patient was followed up for homozygous beta-thalassemia and breast neoplasia with hepatic metastases on chemotherapy. The body mass index of the patient was 18.5 kg/m2. Physical examination showed a thickening of the epidermis with a scaly surface, pigmented, and atrophied areas. We noted neuropsychiatric signs (apathy, irritability, anorexia, and depression) and digestive symptomatology (diarrhea). The laboratory tests revealed hypoproteinemia at 55 g/L, hypoalbuminemia at 21 g/L, and hypocholesterolemia at 0.8 g/L. The diagnosis of pellagra disease was made. Vitamin and protein supplementation was initiated, but the patient committed suicide by puncture of her arteriovenous fistula, causing hemorrhagic shock. Pellagra is usually reported to be associated with malnutrition, chronic alcoholism, and some chemotherapeutic agents. In our patient, pellagra was caused by malnutrition and co-morbidities. Pellagra disease requires multidisciplinary care and can be frequently seen in HD patients due to the associated malnutrition.
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