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Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature.
Am J Case Rep. 2019 Mar 13; 20:330-334.AJ

Abstract

BACKGROUND Beriberi due to thiamine (vitamin B1) deficiency has two clinical presentations. Patients with dry beriberi present with neuropathy, and patients with wet beriberi present with heart failure, with or without neuropathy. Dry beriberi can mimic the most common form of Guillain-Barre syndrome (GBS), an acute inflammatory demyelinating polyradiculoneuropathy (AIDP). Severe thiamine deficiency results in Wernicke's encephalopathy. This report of a case of dry beriberi and Wernicke's encephalopathy due to thiamine deficiency includes a review of the literature. CASE REPORT A 56-year old woman with a history of gallstone pancreatitis and protein-calorie malnutrition was treated six months previously with total parenteral nutrition (TPN). She initially presented at another hospital with paresthesia of the lower limbs, arms, and neck, and symptoms of encephalopathy. Initial diagnosis of GBS was made, based on magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings. Despite five days of intravenous immunoglobulin (IVIG) treatment, her encephalopathy worsened, requiring transfer to our hospital, where she required intubation and treatment with vasopressors. A repeat MRI of her brain showed changes consistent with Wernicke's encephalopathy. Following treatment with high-dose intravenous thiamine, her mental status improved within 48 hours, and by the third hospital day, she no longer required intubation. CONCLUSIONS Symptoms and signs of dry beriberi due to thiamine deficiency can mimic those of acute or chronic GBS. However, thiamine repletion leads to rapid clinical improvement and can prevent irreversible neurologic sequelae, including Korsakoff syndrome. Clinicians should consider thiamine deficiency in malnourished patients presenting with symptoms and signs of GBS.

Authors+Show Affiliations

Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. Department of Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.University of Colorado Internal Medicine Residency Training Program, University of Colorado, Aurora, CO, USA.University of Colorado Internal Medicine Residency Training Program, University of Colorado, Aurora, CO, USA.Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30862772

Citation

Shible, Ahmed A., et al. "Dry Beriberi Due to Thiamine Deficiency Associated With Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré Syndrome: a Case Report and Review of the Literature." The American Journal of Case Reports, vol. 20, 2019, pp. 330-334.
Shible AA, Ramadurai D, Gergen D, et al. Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. Am J Case Rep. 2019;20:330-334.
Shible, A. A., Ramadurai, D., Gergen, D., & Reynolds, P. M. (2019). Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. The American Journal of Case Reports, 20, 330-334. https://doi.org/10.12659/AJCR.914051
Shible AA, et al. Dry Beriberi Due to Thiamine Deficiency Associated With Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré Syndrome: a Case Report and Review of the Literature. Am J Case Rep. 2019 Mar 13;20:330-334. PubMed PMID: 30862772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. AU - Shible,Ahmed A, AU - Ramadurai,Deepa, AU - Gergen,Daniel, AU - Reynolds,Paul M, Y1 - 2019/03/13/ PY - 2019/3/14/entrez PY - 2019/3/14/pubmed PY - 2019/8/14/medline SP - 330 EP - 334 JF - The American journal of case reports JO - Am J Case Rep VL - 20 N2 - BACKGROUND Beriberi due to thiamine (vitamin B1) deficiency has two clinical presentations. Patients with dry beriberi present with neuropathy, and patients with wet beriberi present with heart failure, with or without neuropathy. Dry beriberi can mimic the most common form of Guillain-Barre syndrome (GBS), an acute inflammatory demyelinating polyradiculoneuropathy (AIDP). Severe thiamine deficiency results in Wernicke's encephalopathy. This report of a case of dry beriberi and Wernicke's encephalopathy due to thiamine deficiency includes a review of the literature. CASE REPORT A 56-year old woman with a history of gallstone pancreatitis and protein-calorie malnutrition was treated six months previously with total parenteral nutrition (TPN). She initially presented at another hospital with paresthesia of the lower limbs, arms, and neck, and symptoms of encephalopathy. Initial diagnosis of GBS was made, based on magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings. Despite five days of intravenous immunoglobulin (IVIG) treatment, her encephalopathy worsened, requiring transfer to our hospital, where she required intubation and treatment with vasopressors. A repeat MRI of her brain showed changes consistent with Wernicke's encephalopathy. Following treatment with high-dose intravenous thiamine, her mental status improved within 48 hours, and by the third hospital day, she no longer required intubation. CONCLUSIONS Symptoms and signs of dry beriberi due to thiamine deficiency can mimic those of acute or chronic GBS. However, thiamine repletion leads to rapid clinical improvement and can prevent irreversible neurologic sequelae, including Korsakoff syndrome. Clinicians should consider thiamine deficiency in malnourished patients presenting with symptoms and signs of GBS. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/30862772/Dry_Beriberi_Due_to_Thiamine_Deficiency_Associated_with_Peripheral_Neuropathy_and_Wernicke's_Encephalopathy_Mimicking_Guillain_Barré_syndrome:_A_Case_Report_and_Review_of_the_Literature_ DB - PRIME DP - Unbound Medicine ER -