SHM Converge Scientific Abstract ePoster Gallery-Wernickes Encephalopathy Presenting as Sepsis Mimic

Pdf Summary

Wernicke’s encephalopathy (WE) is an underdiagnosed neurologic emergency caused by thiamine deficiency and associated with high mortality. This case describes a 65-year-old woman with a history of mood disorder and alcohol use who presented with disorganized behavior and visual hallucinations. On exam, she appeared frail and comatose with anisocoria. Her workup showed severe electrolyte abnormalities and leukocytosis (WBC 18,000). Although initially afebrile, she later developed hypothermia and hypotension, raising concern for sepsis. Infectious evaluation was negative, and CT brain was unrevealing.<br /><br />She was empirically treated with broad-spectrum antibiotics, including vancomycin and piperacillin-tazobactam, but her mental status did not improve. MRI of the brain later showed bilateral increased signal in the medial thalami, periventricular white matter around the third ventricle, and periaqueductal gray matter, findings suspicious for WE. Unfortunately, the delayed diagnosis contributed to an aspiration event and fatal outcome.<br /><br />The report emphasizes that WE is diagnosed before death in only about 15% of cases. While alcoholism is the most common risk factor in the United States, WE can occur in any state of nutritional deficiency. The classic triad of mental status changes, ocular dysfunction, and gait disturbance is present in only a minority of patients, making diagnosis difficult. Hypothermia, hypotension, and coma can mimic sepsis and delay recognition.<br /><br />The key lesson is that WE should be considered early in alcoholic or malnourished patients presenting with sepsis-like symptoms. Prompt thiamine administration is the primary treatment and is essential to prevent irreversible injury and death.

Asset Subtitle

Jasreen Kaur

Meta Tag

Author List Jasreen Kaur, Tavleen Singh

Category Clinical Vignettes

Concept Wernicke Encephalopathy

Concept Thiamine Deficiency

Concept Altered Mental Status

Concept Thiamine

Concept Ocular Dysfunction

Distinguished Non-Finalist

Presenter Organization Team Health

Presenting Author Jasreen Kaur

Track Adult

Keywords

Wernicke encephalopathy

thiamine deficiency

alcohol use disorder

mental status changes

visual hallucinations

hypothermia

hypotension

MRI medial thalami

sepsis mimic

thiamine administration

Wernicke Encephalopathy

Thiamine Deficiency

Altered Mental Status

Thiamine

Ocular Dysfunction