Pellagra From Tryptophan Depletion in Carcinoid Syndrome due to a Pulmonary Atypical Carcinoid Neuroendocrine Tumor

Key Points

• The study aims to highlight the occurrence of pellagra due to niacin deficiency in patients with carcinoid syndrome from neuroendocrine tumors.
• Observed patients with pulmonary atypical carcinoid tumors exhibiting chronic diarrhea and skin changes.
• Identified cases presenting with atypical symptoms of pellagra.
• Considered the administration of nicotinamide as an empiric treatment.
• Pellagra presented as subtle skin changes instead of classical symptoms.
• Clinical suspicion of niacin deficiency was recommended in patients with chronic diarrhea.
• Nicotinamide administration was suggested even without niacin assay availability.