Abstract:
Pellagra is caused by cellular deficiency of niacin or its precursor amino acid, tryptophan. Isoniazid
preventive therapy (IPT) is the administration of isoniazid (INH) to latent tuberculosis (TB) infection
affected people preventing advancement to active TB disease. Although potentially life-saving for human
immunodeficiency virus (HIV)-infected people with no active TB, IPT is arguably a possible player in
pellagra in addition to well-known malnourishment determinants particularly in developing nations
where diagnosis is often overlooked or delayed.
A case study examines clinical presentation and possible causes of pellagra, in HIV+ patient on
isoniazid prophylaxis. The 30 year old female on routine antiretroviral therapy presented with diarrhea,
abdominal discomfort, painful swallowing, and epigastric pain, facial rash spread on the forehead, nose,
cheeks and the chin, upper and lower limbs. Withdrawal of isoniazid, administration of nicotinamide and
niacin supplements showed clinical improvementin four weeks. Decreased serum tryptophan in persons
living with HIV (PLHIV) under IPT and lack of minimum dietary proteins threshold would be pointers to
isoniazid induced pellagra risk. Appropriate dietary intake and counseling ought to be emphasized
among PLHIV. Tryptophan and nicotinamide serum levels should be part of baseline investigations in
PLHIV starting IPT and where feasible clinically, niacin/nicotinamide supplementation be adopted.
