Chronic Diarrhea in a dri...

A 56-year-old male patient with a history of alcohol use disorder and coronary artery disease treated with stent placement in 2013 and four subsequent coronary artery bypass grafts in 2014 presented to the emergency room with complaints of diarrhoea. He sought assistance for discontinuing alcohol use. The patient had a history of alcohol use spanning 40 years, with increased consumption over the past 2 years due to chronic pain resulting from a work-related injury to his left hand. Over the course of 2 years, he experienced daily episodes of loose, watery, nonbloody stools and unintentionally lost 27 kg weight while on a diet. He reported multiple falls while intoxicated, a burning sensation in the soles of his feet, and nonpruritic skin changes on the anterior surface of both arms and the right side of his face. He was consuming half a gallon of liquor daily, with his last drink being in the morning before the presentation. He exhibited withdrawal symptoms such as tremors and hallucinations. Despite being afebrile, his pulse rate was elevated at 107 beats per minute, and his blood pressure was measured at 158/102 mm Hg. He displayed signs of inattention and confusion, as evidenced by a Montreal Cognitive Assessment score of 20. His bowel sounds were normal, and upon palpation, his abdomen was scaphoid, soft, and non-tender. Additionally, a raised lesion measuring 1 × 1 cm was observed on his right cheek, along with symmetrical, well-demarcated areas of patchy, scaly erythema on the sun-exposed dorsal surfaces of both forearms (Figures 1 and 2). A clinical diagnosis of pellagra was established.