A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis

폐결핵 치료중 Isoniazid에 의해 발생한 Pellagra 1례

  • Jeon, Ho Seok (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Han, Min Soo (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Ahn, Ju Eui (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Lee, Yang Deok (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Cho, Yongseon (Department of Internal Medicine, Eulji University School of Medicine)
  • 전호석 (을지대학교 의과대학 내과학교실) ;
  • 한민수 (을지대학교 의과대학 내과학교실) ;
  • 안주의 (을지대학교 의과대학 내과학교실) ;
  • 이양덕 (을지대학교 의과대학 내과학교실) ;
  • 조용선 (을지대학교 의과대학 내과학교실)
  • Received : 2004.03.26
  • Accepted : 2004.07.21
  • Published : 2004.08.30

Abstract

A Case of Pellagra Induced by Isoniazid during Treatment of Pulmonary Tuberculosis Pellagra is a disease caused by a deficiency of nicotinic acid or niacin. It is mostly found among people eating corn-based diets in parts of China, Africa and India. It is also induced by drugs, such as isoniazid or 5-fluorouracil. Isoniazid inhibits the conversion of tryptophan to niacin and may induce pellagra, particularly in poorly nourished patients. Pellagra should be suspected whenever tuberculous patients under the treatment with isoniazid develop mental, neurological or gastrointestinal symptoms, even in the absence of typical skin changes. Herein, our experienced of a case of pellagra induced by isoniazid during treatment of pulmonary tuberculosis is reported. The patient was referred due to a skin rash and drowsy mental status. Her skin lesion developed during treatment for pulmonary tuberculosis. Her symptoms were improved after discontinuation of antituberculous agents and on the administration of nicotinamide.

항결핵제중 isoniazid는 nicotinic acid의 합성을 방해하여 pellagra의 발생을 초래할 수 있다. 저자들은 70세 여자 환자에서 폐결핵 치료중 isoniazid에 의해 발생한 pellagra 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellagra despite pyridoxine supplementation. Clin Exp Dermatol 1999 May;24(3): 167-9
  2. Bender DA, Russell-Jones R. Isoniazid-induced pellagra despite vitamin-B6 supplementation. Lancet 1979 Nov 24;2(8152):1125-6
  3. Harrington CI. A case of pellagra induced by isoniazid therapy. Practitioner 1977 May;218(1307):716-7
  4. Ishii N, Nishihara Y. Pellagra encephalopathy among tuberculous patients: its relation to isoniazid therapy. J Neurol Neurosurg Psychiatry 1985 Jul;48(7):628-34
  5. Burke GJ, Hlangabeza T. Isoniazid-induced pellagra in a patient on vitamin B supplement. S Afr Med J 1977 May 14;51(20):719
  6. Meyrick Thomas RH, Rowland Payne CM, Black MM. Isoniazid-induced pellagra. Br Med J (Clin Res Ed) 1981 Jul 25;283(6286):287-8
  7. Stevens HP, Ostlere LS, Begent RH, Dooley JS, Rustin MH. Pellagra secondary to 5-fluorouracil. Br J Dermatol 1993 May;128(5):578-80
  8. McConnell RB, Cheetham HD. Acute pellagra during isoniazid therapy. Lancet 1952 Nov 15;2(20):959-60