Parkinsonian Features in a Case of Pellagra: A Historical Report

Background: Pellagra is a systemic disease caused by dietary deficiency of niacin (vitamin B3) and clinically characterized by dermatitis, diarrhea, and dementia (the “three Ds”), plus complex neuropsychiatric symptoms and Parkinsonian features. The neuropsychiatric and motor abnormalities reported by pellagrins have received little attention in the modern medical literature, despite their recognition in early descriptions of pellagra. Case History: We present the English translation of the first detailed description of an original case of pellagra with Parkinsonian features, reported in a clinical note by Dr. Giuseppe Paravicini one century ago. Felice, the patient, was gravely tainted with hereditary defects, as documented by his family tree. In addition to pellagra, he presented with a wide spectrum of motor symptoms, including muscular spasms, contractures, tremor, and peculiar gait abnormalities. Paravicini’s clinical description provided compelling evidence for the diagnosis of Parkinson’s disease. Conclusions: Pellagra and Parkinson’s disease could share some basic pathophysiological mechanisms at the level of nicotinamide metabolism, resulting in mitochondrial dysfunction and alterations in dopaminergic pathways. Specifically, the manifestation of Parkinsonian features in pellagra are not to be missed: although improved nutritional habits in developed economies have led to a decrease in attention to pellagra and its pathophysiological bases, some cases have recently been associated with alcohol abuse and HIV infection, and there is evidence suggesting that this condition might be on the raise in both developing countries and underprivileged segments of Western society. Paravicini’s detailed account of a case of pellagra associated with Parkinsonism still provides useful clinical insights on two conditions showing similarities in both clinical and pathogenetic aspects.