title: Pellagra in a patient with primary Sjögren's syndrome.
abstract: A 27-year-old woman presented with persistent dryness of the mouth and eyes. She presented with permanent photodistributed rash involving the face and distal extremities. Laboratory tests showed positive Sjögren's syndrome (SS)-A and SS-B antibodies. Histological examination of minor salivary gland biopsy revealed inflammatory infiltration grade 4 according to Chisholm's classification. Skin biopsy showed acanthosis, hyperkeratosis in the epidermis and little inflammatory infiltrate in the dermis. There was an infiltration of CD4 T lymphocytes in the dermis. Based on the characteristics of the dermatitis and on a rapid response to niacin replacement, the diagnosis of pellagra was carried out. A complete resolution of the dermatological signs was obtained within 2 months. To the best of our knowledge, the association between primary SS and pellagra has never been reported. We emphasise the possible mechanisms of this association.
authors.affiliation: Department of Internal Medicine, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Imed
authors.initials: I
authors.lastname: Ben Ghorbel
authors.affiliation: Department of Dermatology, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Noureddine
authors.initials: N
authors.lastname: Litaiem
authors.affiliation: Department of Pathology, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Ines
authors.initials: I
authors.lastname: Chelly
authors.affiliation: Department of Internal Medicine, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Habib
authors.initials: H
authors.lastname: Houman
mesh_terms: D000328:Adult; D005076:Exanthema / Q000209:etiology; D005148:Facial Dermatoses / Q000209:etiology; D005260:Female; D006229:Hand Dermatoses / Q000209:etiology; D006801:Humans; D010383:Pellagra / Q000188:drug therapy / Q000209:etiology*; D012859:Sjogren's Syndrome / Q000150:complications*; D016896:Treatment Outcome