Question

A 42-year-old homeless man is admitted to the hospital with fatigue and chest pain. He states that he has been having fever, night sweats, nausea, vomiting, diarrhea, weight loss, and a burning sensation in the mouth. He also notes a sensation of skin burning, increased skin pigmentation, and emotional instability over the past 3 - 4 months.

Physical examination reveals a bronze skin tone, several missing teeth, and a low-grade fever. Laboratory analysis revealed a normal CBC, WBC, and urinalysis. A PPD was performed and was found to be negative. Serum transferring is normal.

What statement concerning this patient's condition is true?

1. It is caused by a protein deficiency
2. Foods rich in tryptophan may help to compensate for this deficiency
3. It is a common condition in the United States
4. It affects men more than women
5. It is difficult to treat

Answer 1

The patient's symptoms are indicative of pellagra, which can be treated with foods rich in tryptophan or niacin supplementation.

Step-by-step explanation:

The patient's symptoms suggest a case of pellagra, which is a condition caused by a deficiency in niacin (vitamin B3) or tryptophan. Pellagra is characterized by the 'three Ds': dermatitis, diarrhea, and dementia. Due to the symptoms described such as weight loss, fever, night sweats, gastrointestinal symptoms, a burning sensation in the mouth, increased skin pigmentation, emotional instability, and especially the bronze skin tone, statement 2, "Foods rich in tryptophan may help to compensate for this deficiency," is true. Tryptophan can be converted into niacin in the body. Pellagra was once more common in the United States when the diet was heavily corn-based, but it is now rare in developed countries due to better overall nutrition. Its treatment is typically straightforward with niacin supplementation.