Crohn's disease associated with pellagra and increased excretion of 5-hydroxyindolacetic acid.

Abstract

A 47-year-old woman with seronegative polyarthritis, diarrhea, and photosensitivity dermatitis was found to have Crohn's disease and pellagra. The presence of high values of 5-hydroxyindolacetic acid in the urine began the exhaustive investigations and finally enterotomy. No mass lesion was found. Argyrophilic cells were not increased in areas of inflamed intestinal mucosa or the normal mucosa. The disagreement between biochemical and histologic findings was attributed to sampling error. Antiinflammatory treatment for Crohn's disease was given and the gastrointestinal and articular symptoms improved, excretion of 5-hydroxyindolacetic acid returned to normal and there was no relapse of pellagra. Pellagra as a complication of Crohn's disease has been described in 4 cases; malnutrition and intestinal malabsorption were the proposed mechanisms for the niacin deficiency and pellagra of those patients. In the current case, the pathogenesis of pellagra may be accounted to wastage of tryptophan by an increased pool of intestinal argyrophilic cells, suggested by increased urinary excretion of 5-hydroxyindolacetic acid.

• Authors: R Abu-Qurshin, J E Naschitz, E Zuckermann, E Nash, S Eldar, D Yeshurun
• Journal: The American journal of the medical sciences (Am J Med Sci) Vol. 313 Issue 2 Pg. 111-3 (Feb 1997) ISSN: 0002-9629 [Print] United States
• PMID: 9030678 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Niacin
• Hydroxyindoleacetic Acid
• Tryptophan

Topics

• Anti-Inflammatory Agents (therapeutic use)
• Crohn Disease (complications)
• Female
• Humans
• Hydroxyindoleacetic Acid (metabolism, urine)
• Intestinal Absorption (physiology)
• Intestines (pathology)
• Middle Aged
• Niacin (deficiency)
• Nutrition Disorders
• Pellagra (etiology)
• Tryptophan (metabolism)