Parkinsonian features in a case of pellagra: a historical report

Pellagra is a complex systemic disease resulting from inadequate dietary intake of coenzyme precursors nicotinamide and tryptophan. Improved nutritional habits in most developed economies have led to a decrease in clinicians' and researchers' attention to this condition and its pathophysiological bases, although new cases of pellagra have recently been identified in association with alcohol abuse and HIV infection in Western countries. Pellagra is characterized by a complex clinical picture, which can include neuropsychiatric symptoms and Parkinsonian features. Interestingly, 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. Both neuropsychiatric and motor symptoms were mentioned in historical reports of pellagra cohorts. Here we present the English translation of the first detailed description of an original case of pellagra with Parkinsonian features, documented in a clinical note by Dr Giuseppe Paravicini one century ago.