SHM Converge Scientific Abstract ePoster Gallery-Beriberi Scary: A Case of Unexpected Thiamine-Deficient Neuropathy

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This case describes a 36-year-old woman who developed one month of progressive depressed mood, anorexia, severe weight loss, weakness, blurry vision, pain with walking, and worsening functional decline after her father’s death. She eventually required a rollator and help with transfers. Family also noticed odd behavior and visual hallucinations. Although alcohol and drug use were absent, her symptoms initially raised concern for Guillain-Barré syndrome and even a possible functional disorder related to complicated grief.<br /><br />Her neurologic exam showed delayed cognitive processing, impaired memory and attention, nystagmus, decreased visual acuity, sensorineural hearing loss, bilateral lower-extremity weakness, sensory loss in multiple modalities, areflexia, hypotonia, gait ataxia, and sensory ataxia. Ophthalmologic findings included peripapillary white lesions and intraretinal flame hemorrhages. MRI showed T2 hyperintensity in the periaqueductal gray and hypothalamus, supporting thiamine deficiency. Labs confirmed severe malnutrition: thiamine was low at 20 nmol/L, vitamin B12 and vitamin D were also low, and folate was borderline.<br /><br />She was treated with high-dose IV thiamine, followed by oral supplementation and temporary enteral nutrition. Her vision, hearing, and strength gradually improved, though neuropathic pain persisted at discharge to acute rehab. The final diagnosis was thiamine deficiency causing dry beriberi and Wernicke’s encephalopathy due to malnutrition from complicated grief.<br /><br />The key teaching point is that thiamine deficiency can cause rapid, severe, multisystem neurologic disease after only 1–3 months of inadequate intake. Clinicians should maintain a high suspicion for beriberi even without alcohol use, especially in patients with objective neurologic findings and significant nutritional risk. Prompt recognition and aggressive treatment are essential to prevent irreversible brain and nerve injury.

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Suchita S. Sata

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Author List Diana Mehedint, Paige Lambert, Rebecca H. Lumsden, Stephanie Reyes, Suchita S. Sata

Category Clinical Vignettes

Concept Thiamine Deficiency

Concept Wernicke Encephalopathy

Concept High-Dose Thiamine Replacement

Concept Dry Beriberi

Concept Malnutrition

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Suchita S. Sata

Track Adult

Keywords

thiamine deficiency

dry beriberi

Wernicke encephalopathy

malnutrition

complicated grief

neurologic decline

visual hallucinations

sensorineural hearing loss

ataxia

IV thiamine

Thiamine Deficiency

Wernicke Encephalopathy

High-Dose Thiamine Replacement

Dry Beriberi

Malnutrition