Pellagra is a rare condition caused by the deficiency of Niacin (vitamin B-3). The disease is more prominent in areas of body with high rates of cell turnover, such as skin and Gastrointestinal tract. It is characterized by three Ds, Dementia, diarrhea and dermatitis. The patient typically presents with a rash on face, hands, feet, lips and sometimes around, the neck (casal necklace). Apart from dermatitis some symptoms of dementia such as depression, confusion and delusions may also be present but they are usually hard to detect. Pellagra can be classified into two types, primary pellagra, and secondary pellagra. Primary pellagra is caused by insufficient Niacin and tryptophan in diet. Whereas, secondary pellagra occurs when the body is unable to absorb an adequate amount of Niacin. Excessive intake of alcohol and certain anticonvulsant medications are a common cause of secondary pellagra. Pellagra is easily treated by oral Niacin, if left untreated, death is the outcome .
Petechiae they need rheumatologist full metabolic panel Western blot essay Elisa essay and atrial blood gas look for a kind of arthritis. Or rheumatic fever with rash yellowish reddish skin a pupura that is not jaundice and admit on infectious disease ward