A case of pellagra and a South Carolina history of the disorder.

This case raises many questions about pellagra in the 21st century. Why are so few cases diagnosed in industrialized societies? Are physicians and other health care providers overlooking many cases? Should we treat any "sick" person and those with unexplained skin, mental status changes or gastrointestinal complaints with safe, inexpensive doses of niacin? Should an inexpensive, reliable laboratory test for pellagra be developed? Clearly the quote, "if you keep pellagra in mind, you will recognize it when you see it" is valid. But perhaps that is not sufficient and pellagra is frequently invisible.