CREUTZFELDT-JAKOB DISEASE LIKE SYMPTOMS IN A PATIENT ON LONG TERM ANTI-TUBERCULOUS TREATMENT PELLAGRA INDUCED BY ANTITUBERCULOUS AGENTS

• Published in: Japanese Journal of National Medical Services Vol. 48; no. 2; pp. 114 - 118
• Main Authors: KAWAGUCHI, Satoshi, ISEKI, Masachika, TAKAHASHI, Katsuro, HIROTA, Noriyoshi, KANDA, Tetsuro, NAKANE, Yoshibumi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 20.02.1994
• Subjects: Creutzfeldt-Jakob disease; ethionamide; pellagra; pellagra sine pelle agra
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.48.114

Creutzfeldt-Jakob disease (CJD) is transmissible, subacute spongiform encephalopathy with many symptoms. It shows psychotic symptoms such as apathy, depression, memo-ry disturbance, anxiety, and delirium, and neurotic symptoms such as headache, visual impairment, vertigo, gait disturbance and myoclonus. Unfortunately, there is no effec-tive therapy yet. Pellagra, well known as 3D (dermatitis, diarrhea and dementia), is undernutritional disease due to the lack of nicotinic acid. Therefore nicotinic acid im-proves this disease remarkably. Both CJD and pellagra show similar symptoms, such as apathy, depression, memory disturbance, gait disturbance, myoclonus and so on. Clin-ically it is difficult to discriminate between CJD and pellagra. We experienced a case of ‘pellagra sine pelle agra’ in a 50-year-old female patient who showed apathy, gait disturbance, memory disturbance without dermatitis and diarrhea. For 3 years prior to the onset of pellagra, she had been prescribed anti-tuberculous agents (etionamide et al). After a half year since the onset she fell in vegetable state accompa-nying myoclonus. Her clinical diagnosis was CJD at that point. After autopsy, her pathological diagnosis was pellagra. In Japan recently, the number of pellagra patients has been decreasing due to the improvement of general nutrition. In such condition less attention has been paid to pel-lagra as diagnosis distinguished from CJD. But ethionamide inhibits the conversion of tryptophan to niacin and may induce pellagra. We must pay more attention with pella-gra to tuberculous patients developing mental or neurological symptoms under treatment with ethionamide.