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A 110-year-old woman, with recent history of dementia and intermittent diarrhea, presented with recurrence of a painful lilaceous eruption, 3 months earlier, on the back of legs, due to sun exposure of this area. On examination, patient was confused. Dermatological examination revealed well-defined violaceous plaques with erythematous margins and large area of blistering on her legs with surrounding hyperpigmentation (Figs. 1a – 1d). Neurological examination noticed a spastic weakness with power of 4/5 in all the four limbs with rigidity at both the wrist joints. The deep tendon reflexes were bilaterally brisk. Abdominal examination was normal. Directed investigations objected an anemia with low levels of calcium, phosphorus and magnesium. There were no signs of chronic liver disease. Serum niacin level estimation was conducted, which was low. The diagnosis retained was pellagra and treated with niacin 300 mg a day, and vitamin supplementation with hyperprotidic diet, were started. We noted a significant improvement of dermatological, neurological and digestive symptoms at 2 weeks.

A photo-distributed rash with neurological problems in an elderly man: Don’t forget pellagra!