We report a case of a 50-year old homeless male who presented with pellagra and pellagrous encephalopathy. The characteristic - if not pathognomonic - skin lesions of pellagra support its diagnosis on solely clinical grounds. Clinicians should keep a high index of suspicion, in certain patient groups, in order to early diagnose and cure this potentially fatal but treatable disease.
Keywords: niacin; pellagra; pellagrous encephalopathy; vitamin B3 deficiency.