Evidence map›Paper›PMID 42334825›Full record

ArticleForensic science, medicine, and pathology2026

Recognizing pellagra with Casal's necklace: a fatal case of anorexia nervosa.

Atsushi Yamada, Kana Unuma, Nobutaka Arai, Ryohei Kuroda, Naoka Umemoto, Takanao Matsumoto, Osamu Kitamura

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Article in Forensic science, medicine, and pathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Atsushi YamadaDepartment of Forensic Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (ST), 1-5-45 Yushima, Bunkyo- ku, Tokyo, 113-8519, Japan. yamada.a.2386@m.isct.ac.jp.ORCID http://orcid.org/0000-0001-7598-5877
Kana UnumaDepartment of Forensic Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (ST), 1-5-45 Yushima, Bunkyo- ku, Tokyo, 113-8519, Japan.
Nobutaka AraiDepartment of Forensic Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (ST), 1-5-45 Yushima, Bunkyo- ku, Tokyo, 113-8519, Japan.
Ryohei KurodaDepartment of Forensic Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (ST), 1-5-45 Yushima, Bunkyo- ku, Tokyo, 113-8519, Japan.
Naoka UmemotoDepartment of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Takanao MatsumotoMatsumoto Dermatology and Plastic Surgery Clinic, Saitama, Japan.
Osamu KitamuraDepartment of Legal Medicine, Kyorin University School of Medicine, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Pellagra is a nutritional deficiency caused by the inadequate intake or metabolism of niacin (vitamin B3) and its precursor tryptophan. While pellagra is now rare in developed countries, individuals with eating disorders such as anorexia nervosa or chronic alcoholism remain at risk of developing this condition. We report a fatal case of pellagra in a woman with anorexia nervosa. Autopsy revealed severe emaciation, Casal's necklace, and additional cutaneous findings, including Russell's sign. Histopathological examination of the neck lesion revealed characteristic psoriasiform changes. Postmortem serum analysis revealed a markedly reduced tryptophan concentration (16.1 nmol/mL; reference range: 40.9-68 nmol/mL), consistent with the diagnosis of pellagra. This case highlights the diagnostic importance of integrated histopathology, cutaneous findings, and postmortem serum amino acid profiling in identifying fatal nutritional deficiencies. Furthermore, it emphasizes the need to consider pellagra in at-risk populations, even in modern forensic settings.

Indexed as

Amino acid profilingAnorexia nervosaCasal’s necklaceForensic autopsyPellagra

Identifiers

PMID42334825

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.