Pellagra is a rare disease in Great Britain. The majority of cases occur among patients in mental hospitals and institutions (Stannus and Gibbons, 1934), and more recently it has been described as an accompaniment or complication of a chronic psychosis (Hardwick, 1946). Sporadic cases do arise in the general population (Davis and Hinden, 1941), but it is likely that in many instances the disease goes unrecognized (Deeny, 1942). Pellagra is particularly uncommon in British children (Greenfield and Holmes, 1939), although observers in areas where the disease is rife are of the opinion that it is found more frequently in children than in adults (Weston and Weston, 1948).
Mental symptoms are frequent in pellagra and may, in fact, precede the other manifestations (Sydenstricker, 1943). Severe psychoses occur in untreated cases and depressive, manic and paranoid reactions have been described (Hardwick, 1946). In children, however, symptoms are usually mild and mania or delirium is not often present (Holt and Mcintosh, 1953); therefore this case of pellagra with a psychotic reaction in a 10-year-old English schoolboy may be of interest.