A 42-Year-Old Man Who Recently Emigrated from Northern Africa Comes

A 42-year-old man who recently emigrated from Northern Africa comes to the clinic due to a 1-month history of abdominal pain and watery diarrhea.  He has also had a skin rash for the last 2 months that gets worse with sun exposure.  In addition, the patient has felt depressed recently and has loss of appetite with mild weight loss.  Medical history is notable for latent tuberculosis, for which he is currently taking isoniazid and pyridoxine.  The patient takes no other medications and does not use tobacco, alcohol, or illicit drugs.  He is vegetarian, and his diet consists mostly of corn and other cereal grains.  On examination, there is a pigmented scaly skin rash in the malar distribution of his face, on his neck, and on the back of his hands.  He also has mild, diffuse abdominal tenderness.  Neurologic examination, including distal sensation and gait, is normal.  Liver function tests are normal.  Which of the following is the most likely diagnosis?

A) Acute intermittent porphyria
B) Isoniazid hypersensitivity
C) Pellagra
D) Seborrheic dermatitis
E) Systemic lupus erythematosus
F) Ulcerative colitis

Correct Answer:

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