Disclosures: Zachary T. Dawes, DO: No financial relationships or conflicts of interest

Case Diagnosis: The patient developed thiamine deficiency resulting in Wernicke’s encephalopathy and polyneuropathy.

Case Description or Program Description: A 17-year-old female presented to the hospital with altered mental status and severe weakness following a period of self-imposed restricted eating. The patient was in a detention facility for 2 months and had been eating less. She stopped eating entirely 2 weeks prior to presentation. She developed burning leg pain which progressed to the inability to walk. On presentation, she was noted to experience auditory hallucinations, disorientation, and extremity weakness pronounced distally. Her patellar reflexes were absent bilaterally. Initial workup, including serum electrolytes, urine drug screen, thyroid function, lumbar puncture, and brain MRI were unremarkable. Nutritional workup revealed an undetectable thiamine level. She developed cardiomyopathy with severely decreased ejection fraction, requiring a brief stay in the intensive care unit.

Setting: Pediatric Inpatient Rehabilitation Facility

Assessment/Results: Treatment included intravenous thiamine, followed by oral replacement. This resulted in improvement in mental status and cardiac function. An electromyogram and nerve conduction study showed axonal polyneuropathy—a pattern seen in thiamine deficiency. Comprehensive rehabilitation targeted persistent weakness and cognitive deficits. The patient regained limited functional use of her right hand but required assistance for most activities of daily living. She progressed with transfers and weight bearing using orthotics applied to the wrists and ankles. She ultimately performed slide board transfers with standby assistance.

Discussion (relevance): Thiamine deficiency can cause weakness, neuropathic pain, and mental status changes. Although commonly associated with chronic alcohol use, thiamine deficiency may be the result of malabsorption, insufficient intake or refeeding syndrome.

Conclusions: Thiamine is essential for nerve and cardiac tissue. Untreated deficiency may cause Wernicke’s encephalopathy and wet beriberi, which may persist chronically as Korsakoff syndrome and polyneuropathy. Chronic effects of thiamine deficiency may be irreversible, thus creating a challenging rehabilitation course.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/starvation-induced-thiamine-deficiency-and-the-development-of-wernickes-encephalopathy-and-polyneuropathy-a-case-report/