SHM Converge Scientific Abstract ePoster Gallery-A Hidden Cause of Encephalopathy: Nutritional Deficiency Following Gastric Bypass

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This case report, <strong>“A Hidden Cause of Encephalopathy: Nutritional Deficiency Following Gastric Bypass,”</strong> describes a woman in her mid-30s with prior <strong>Roux-en-Y gastric bypass</strong> and hypothyroidism who developed <strong>six months of progressive bilateral leg numbness and weakness</strong>, worsening confusion, and abdominal symptoms. On presentation she was febrile, tachycardic, and hypotensive, with mild leukocytosis and CT evidence of <strong>stercoral colitis</strong>, so she was initially treated for presumed sepsis with broad-spectrum antibiotics.

Her hospital course became more complicated with <strong>progressive encephalopathy and hemodynamic instability</strong>, prompting ICU transfer. Extensive neurologic and infectious evaluation, including <strong>MRI, EEG, lumbar puncture, autoimmune/paraneoplastic testing, thyroid studies, and heavy-metal workup</strong>, was unrevealing. Because autoimmune encephalitis was considered, empiric high-dose steroids were started and later stopped. Key labs showed <strong>macrocytic anemia</strong> and <strong>elevated B12 and thiamine</strong>, which could have falsely reassured clinicians. Further testing identified <strong>low fecal elastase</strong>, suggesting pancreatic insufficiency, and <strong>24-hour urine copper</strong> indicated malabsorption; Wilson disease testing was negative.

The patient’s course was also complicated by <strong>rectal ulcer bleeding, aspiration pneumonia with ARDS, and acute kidney injury requiring CRRT</strong>. Ultimately, clinicians initiated <strong>comprehensive vitamin and trace-element repletion</strong> and <strong>pancreatic enzyme replacement</strong>, after which she showed <strong>progressive neurologic improvement</strong> and was discharged to rehabilitation.

The report emphasizes that after bariatric surgery, <strong>severe micronutrient deficiencies—especially copper, zinc, and vitamin B6—can cause encephalopathy and neuropathy even years later</strong>. Diagnostic pitfalls include anchoring on sepsis, premature focus on autoimmune encephalitis, reliance on elevated B12 as reassurance, and failure to routinely order micronutrient testing. Early recognition and targeted replacement are essential to prevent permanent neurologic injury.

Asset Subtitle

Yuliana Kvasha

Meta Tag

Author List Angeliqua Grange, Maryana Yaremko, Nicolas Gisellie, Siad Adam, Tanzeela Shuja, Yuliana Kvasha

Category Clinical Vignettes

Concept Micronutrient Deficiency

Concept Encephalopathy

Concept Peripheral Neuropathy

Concept Copper

Concept Thiamine

Distinguished Non-Finalist

Presenter Organization Rosalind Franklin University of Medicine and Science/Northwestern Medicine McHenry Hospital

Presenting Author Yuliana Kvasha

Track Adult

Keywords

Roux-en-Y gastric bypass

encephalopathy

micronutrient deficiency

copper deficiency

neuropathy

macrocytic anemia

malabsorption

pancreatic insufficiency

autoimmune encephalitis

vitamin repletion

Micronutrient Deficiency

Encephalopathy

Peripheral Neuropathy

Copper

Thiamine