Disclosures: Royce O. Sumayo, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 33-year-old male with encephalopathy, paresthesias, and motor weakness with ambulatory dysfunction secondary to sensorimotor neuropathy due to vitamin malabsorption.

Case Description or Program Description: The patient had a past medical history of colonic interposition after lye ingestion as a child. He had multiple admissions within 2 weeks, first for dehydration due to nausea, vomiting. Esophagogastroduodenoscopy revealed esophageal bile and gastric pouch friability/erosions. He was readmitted 2 days later for bilateral lower extremity paresthesias and gait instability due to presumed diagnosis of Guillain-Barré. Workup included negative neuro-imaging, cerebrospinal fluid with no albuminocytologic dissociation, positive Campylobacter jejuni, negative Lyme IgG/IgM, normal serum protein, elevated free kappa and free lambda with normal ratio, normal serum and urine immunofixation, low B1, normal B6, low Vitamin E, normal gamma tocopherol, elevated IgA, elevated C-reactive protein and erythrocyte sedimentation rate, normal copper, and negative neuronal nuclear antibodies. He was treated with intravenous immunoglobulin and discharged. However 6 days later, he was readmitted for worsening memory, confusion, bilateral lower extremity sensory symptoms and weakness with recurrent falls. Exam was notable for ataxia, nystagmus, and ophthalmoplegia.

Setting: Tertiary Care Hospital

Assessment/Results: Workup during the third admission included repeat neuro-imaging, which was unrevealing, but also Vitamin E 5.2, Vitamin B1 32, Pyridoxine 5, and Vitamin B12 827. He was then started on thiamine 500 mg IV, vitamin E 400 mg daily. Patient clinically improved. He was diagnosed with encephalopathy and ambulatory dysfunction secondary to Wernicke’s encephalopathy in setting of chronic malnutrition, gastrointestinal malabsorption and previous colonic interposition.

Discussion (relevance): To our knowledge, this is the first report of encephalopathy, peripheral neuropathy and ambulatory dysfunction associated with history of colonic interposition.

Conclusions: As this patient presentation and clinical history is distinctively unique, it emphasizes the significance in understanding these etiologies and keeping a comprehensive differential. This would help with earlier diagnosis, treatment and rehabilitation placement thus leading to improved outcomes.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/encephalopathy-ambulatory-dysfunction-in-patient-with-history-of-colonic-interposition-initially-presenting-as-presumed-guillain-barre-syndrome-a-case-report/