Abstract
INTRODUCTION: Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological presentation of pellagra in a long-term alcohol and substance abuser, emphasizing the diagnostic challenges in resource-constrained settings. CASE PRESENTATION: A 36-year-old male with a history of substance abuse presented with multiple symptoms, including hallucinations and neurological deficits. His complex clinical history included alcohol dependence, seizures, and relapses. Physical and neurological examinations revealed characteristic signs of pellagrous encephalopathy. Laboratory findings confirmed anemia and a fatty liver. DISCUSSION: Alcoholic pellagrous encephalopathy (APE) presents a diagnostic challenge due to its atypical symptoms, overlapping with other alcohol-related disorders. Niacin deficiency, central to its pathogenesis, affects neurotransmitter synthesis, contributing to neurological symptoms. Diagnosis relies on clinical presentation, but laboratory tests for niacin levels can aid in confirmation. Neuroimaging can exclude alternative causes. This case underscores the importance of considering pellagrous encephalopathy in alcohol-related disorders with neurological symptoms. CONCLUSION: This case underscores the importance of recognizing atypical presentations of APE in chronic alcohol-dependent individuals. Prompt diagnosis, nutritional correction, and addressing alcohol use are vital for successful management. Healthcare providers must be aware of the diagnostic complexities and socioeconomic barriers hindering timely intervention in APE.