SHM Converge Scientific Abstract ePoster Gallery-Be One With the Virus: Not Just Another Case of Covid-19

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This case describes a 14-year-old previously healthy girl who developed altered mental status, gait difficulty, and gaze abnormalities months after a COVID-19 infection that left her with persistent anosmia and dysgeusia. Over time, her taste disturbance led to severely restricted intake and a 22 kg weight loss, suggesting significant malnutrition.<br /><br />She presented after 3 days of confusion and difficulty walking, with dehydration, tachycardia, hypertension, and reduced orientation. Initial evaluation showed hyponatremia and hypokalemia. CSF studies were unrevealing, and a respiratory viral panel was positive for rhino/enterovirus. Because of concern for acute disseminated encephalomyelitis (ADEM), she was started on steroids and IVIG. However, her condition worsened with encephalopathy, lactic acidosis, and hypotension requiring vasopressors. MRI findings progressed to involve the hypothalamus, thalamus, periaqueductal gray, and mammillary bodies.<br /><br />A low thiamine level of 20 nmol/L confirmed Wernicke’s encephalopathy. She improved significantly after IV thiamine replacement. The discussion emphasizes that Wernicke’s encephalopathy is caused by thiamine deficiency and classically presents with oculomotor dysfunction, ataxia, and altered mental status, though the full triad is often absent, especially in children. The report also notes that wet beriberi can occur from thiamine deficiency and that steroid-induced hyperglycemia may have further worsened thiamine depletion.<br /><br />The key lesson is that persistent dysgeusia after COVID-19 can lead to dangerous nutritional deficiency and life-threatening neurologic illness. Clinicians should consider thiamine deficiency in patients with encephalopathy and poor intake, even when a post-infectious neurologic diagnosis seems more likely.

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Hollis Johnson

Meta Tag

Author List Andrea Hadley, Hollis Johnson, Natalia Perecki, Nicholas Beam

Category Clinical Vignettes

Concept Wernicke Encephalopathy

Concept Thiamine Deficiency

Concept Altered Mental Status

Concept Poor Intake

Concept Neurologic Deterioration

Distinguished Non-Finalist

Presenter Organization Helen DeVos Children's Hospital/Spectrum Health

Presenting Author Hollis Johnson

Track Pediatric

Keywords

Wernicke encephalopathy

thiamine deficiency

COVID-19 anosmia

dysgeusia

malnutrition

encephalopathy

ataxia

oculomotor dysfunction

MRI mammillary bodies

pediatric case

Wernicke Encephalopathy

Thiamine Deficiency

Altered Mental Status

Poor Intake

Neurologic Deterioration