Make the diagnosis, Sherlock!

This is a case recently reported in the Medical Journal of Australia.  A 50-year-old woman presented with a read, painful, scaling rash on her hand an forearms, and around her eyes. She reported that sun exposure aggravated the dermal symptoms. She also gave a history of intermittent diarrhea. Examination revealed a scaly hyperpigmented lesion on her upper chest, in the distribution of a broad collar. The patient was a smoker and said she consumed half a bottle of gin daily. The skin manifestations did not respond to antibiotics or steroids. Click on the following questions to reveal the answers. Was is the diagnosis? expand(document.getElementById('ddet1398770975'));expand(document.getElementById('ddetlink1398770975')) The medical team in this case considered infection, pseudoporphyria, bullous lupus, porphyria cutanea tarda, and phototoxic drug reaction. However, because of the scaly hyperpigmented lesion on the patient’s upper chest, resembling a Casal necklace, they decided that the most likely diagnosis was pellagra. For a picture of the Casal necklace finding, click here. What causes this condition? expand(document.getElementById('ddet1727278147'));expand(document.getElementById('ddetlink1727278147')) Pellagra is caused by deficiency of vitamin B3  (niacin or nicotinic acid). How is the diagnosis confirmed? expand(document.getElementById('ddet1841316279'));expand(document.getElementById('ddetlink1841316279')) The diagnosis is established by a rapid response t...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical dermatitis niacin deficiency pellagra Source Type: news