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AlQasim E, Alawfi A, Hamad A, Alghamdi F, Albaradi BA. Human Herpesvirus-6 Encephalitis Associated With Acute Necrotizing Encephalopathy in an Immunocompetent Child: A Case Report and Literature Review. Cureus 2023; 15:e39897. [PMID: 37404398 PMCID: PMC10316458 DOI: 10.7759/cureus.39897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Human herpesvirus type 6 (HHV-6) is a DNA virus considered a member of the Herpesviridae family. HHV-6 is acquired early in life, when it may cause roseola infantum and nonspecific febrile illnesses which is usually a self-limiting disease before the age of two. Primary HHV-6 encephalitis and acute necrotizing encephalopathy (ANE) are rare diseases to occur in immunocompetent children. We describe an unusual case of HHV-6 encephalitis with mixed features of acute necrotizing encephalopathy and acute disseminated encephalomyelitis and contextualize it with a review of the literature on HHV-6 encephalitis in immunocompetent children. Although the incidence of primary HHV-6 encephalitis is rare in immunocompetent children, HHV-6 encephalitis associated with acute necrotizing encephalopathy is a devastating disease, highly fatal and neurologically damaging disease. Therefore, early testing and diagnosis are crucial as well as effective management of encephalitis with antiviral therapy is highly recommended.
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Affiliation(s)
- Esraa AlQasim
- Pediatric Infectious Diseases, King Fahad Specialist Hospital, Dammam, SAU
| | | | - Abdalazeem Hamad
- Pediatric Infectious Diseases, King Fahad Specialist Hospital, Dammam, SAU
| | - Fouad Alghamdi
- Pediatric Neurology, King Fahad Specialist Hospital, Dammam, SAU
| | - Bandar A Albaradi
- Pediatric Infectious Diseases, King Fahad Specialist Hospital, Dammam, SAU
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A Clinician's View of Wernicke-Korsakoff Syndrome. J Clin Med 2022; 11:jcm11226755. [PMID: 36431232 PMCID: PMC9693280 DOI: 10.3390/jcm11226755] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this article is to improve recognition and treatment of Wernicke-Korsakoff syndrome. It is well known that Korsakoff syndrome is a chronic amnesia resulting from unrecognized or undertreated Wernicke encephalopathy and is caused by thiamine (vitamin B1) deficiency. The clinical presentation of thiamine deficiency includes loss of appetite, dizziness, tachycardia, and urinary bladder retention. These symptoms can be attributed to anticholinergic autonomic dysfunction, as well as confusion or delirium, which is part of the classic triad of Wernicke encephalopathy. Severe concomitant infections including sepsis of unknown origin are common during the Wernicke phase. These infections can be prodromal signs of severe thiamine deficiency, as has been shown in select case descriptions which present infections and lactic acidosis. The clinical symptoms of Wernicke delirium commonly arise within a few days before or during hospitalization and may occur as part of a refeeding syndrome. Wernicke encephalopathy is mostly related to alcohol addiction, but can also occur in other conditions, such as bariatric surgery, hyperemesis gravidarum, and anorexia nervosa. Alcohol related Wernicke encephalopathy may be identified by the presence of a delirium in malnourished alcoholic patients who have trouble walking. The onset of non-alcohol-related Wernicke encephalopathy is often characterized by vomiting, weight loss, and symptoms such as visual complaints due to optic neuropathy in thiamine deficiency. Regarding thiamine therapy, patients with hypomagnesemia may fail to respond to thiamine. This may especially be the case in the context of alcohol withdrawal or in adverse side effects of proton pump inhibitors combined with diuretics. Clinician awareness of the clinical significance of Wernicke delirium, urinary bladder retention, comorbid infections, refeeding syndrome, and hypomagnesemia may contribute to the recognition and treatment of the Wernicke-Korsakoff syndrome.
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Derespina KR, Kaushik S, Mahadeo K, McCabe M. Response to "Thiamin deficiency secondary to loop diuretics, an overlooked cause of multiorgan failure". Nutr Clin Pract 2021; 36:1088-1089. [PMID: 34462961 DOI: 10.1002/ncp.10766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kim R Derespina
- Pediatric Critical Care, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York, New York, USA.,Children's Hospital at Montefiore, Bronx, New York, USA
| | - Shubhi Kaushik
- Pediatric Critical Care, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York, New York, USA.,Children's Hospital at Montefiore, Bronx, New York, USA
| | - Kris Mahadeo
- Children's Hospital at Montefiore, Bronx, New York, USA.,University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Megan McCabe
- Children's Hospital at Montefiore, Bronx, New York, USA
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Derespina KR, Kaushik S, Mahadeo K, McCabe M. Lactic Acidosis Secondary to Thiamin Deficiency Following Autologous Stem Cell Transplantation. Nutr Clin Pract 2020; 36:414-418. [PMID: 32700422 DOI: 10.1002/ncp.10560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 22-month-old female with high-risk neuroblastoma completed 5 cycles of chemotherapy then underwent high-dose chemotherapy with autologous stem cell rescue (ASCR). Parenteral nutrition was administered from day +2 following ASCR, as she was unable to tolerate nasogastric feeds because of grade IV mucositis and vomiting. On day +12, she developed worsening metabolic acidosis with above reportable levels of lactic acid. Given the patient's well clinical appearance and paucity of evidence of end-organ dysfunction on physical examination and on laboratory studies, there was high suspicion that the patient's lactic acidosis did not result from tissue hypoxia and was, in fact, a type B lactic acidosis. Thiamin was empirically administered, with rapid improvement in lactic acidosis. Thiamin deficiency was later confirmed by laboratory studies drawn prior to thiamin administration.
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Affiliation(s)
| | | | - Kris Mahadeo
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Megan McCabe
- Children's Hospital at Montefiore, Bronx, New York, USA
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Imaging Assessment of Complications from Transplantation from Pediatric to Adult Patients: Part 2: Hematopoietic Stem Cell Transplantation. Radiol Clin North Am 2020; 58:569-582. [PMID: 32276704 DOI: 10.1016/j.rcl.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hematopoietic stem cell transplantation is an intravenous transfusion of pluripotent stem cells to repopulate the marrow and restore immunocompetence. However, before transplantation, the patient undergoes a conditioning regimen to eradicate the underlying disease, subsequently resulting in an immunocompromised state. Serious and some life-threatening complications involving any organ can occur. Currently, with advances in hematopoietic stem cell transplantation techniques and posttransplant management, more pediatric patients are now living longer and into their adulthood. The goal of this review article is to discuss the common neurologic, pulmonary, and abdominal complications associated with hematopoietic stem cell transplantation with emphasis on their imaging characteristics.
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HHV-6-Associated Neurological Disease in Children: Epidemiologic, Clinical, Diagnostic, and Treatment Considerations. Pediatr Neurol 2020; 105:10-20. [PMID: 31932119 DOI: 10.1016/j.pediatrneurol.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 02/04/2023]
Abstract
Human herpesviruses 6A and 6B, often referred to collectively as human herpesvirus 6, are a pair of beta-herpesviruses known to cause a variety of clinical syndromes in both immunocompetent and immunocompromised individuals. Most humans are infected with human herpesvirus 6B, and many with human herpesvirus 6A. Primary infection typically occurs in early childhood, although large-scale reviews on the topic are limited. Herein, the authors explore the clinical manifestations of human herpesvirus 6-associated disease in both immunocompetent and immunocompromised pediatric patients, the risk factors for development of human herpesvirus 6-associated neurological disease, the risk of autoimmunity associated with development of active or latent infection, the relevance of human herpesvirus 6-specific diagnostic tests, and the medications used to treat human herpesvirus 6. The goal of this review is to improve the current understanding of human herpesvirus 6 in pediatric populations and to examine the most effective diagnostic and therapeutic interventions in this disease state.
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Abstract
Neurologic disturbances including encephalopathy, seizures, and focal deficits complicate the course 10-30% of patients undergoing organ or stem cell transplantation. While much or this morbidity is multifactorial and often associated with extra-cerebral dysfunction (e.g., graft dysfunction, metabolic derangements), immunosuppressive drugs also contribute significantly. This can either be through direct toxicity (e.g., posterior reversible encephalopathy syndrome from calcineurin inhibitors such as tacrolimus in the acute postoperative period) or by facilitating opportunistic infections in the months after transplantation. Other neurologic syndromes such as akinetic mutism and osmotic demyelination may also occur. While much of this neurologic dysfunction may be reversible if related to metabolic factors or drug toxicity (and the etiology is recognized and reversed), cases of multifocal cerebral infarction, hemorrhage, or infection may have poor outcomes. As transplant patients survive longer, delayed infections (such as progressive multifocal leukoencephalopathy) and post-transplant malignancies are increasingly reported.
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Bonardi M, Turpini E, Sanfilippo G, Mina T, Tolva A, Zappoli Thyrion F. Brain Imaging Findings and Neurologic Complications after Allogenic Hematopoietic Stem Cell Transplantation in Children. Radiographics 2018; 38:1223-1238. [PMID: 29995615 DOI: 10.1148/rg.2018170139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the only therapy for a subset of patients with malignant and nonmalignant diseases. Central nervous system (CNS) complications continue to be an important cause of morbidity and significantly contribute to mortality after HSCT. These complications include infections, cerebrovascular lesions, therapy-induced diseases, metabolic disturbances, and post-HSCT carcinogenesis. Following HSCT, three phases can be identified on the basis of the patient's immune status: the pre-engraftment period (<30 days after HSCT), the early postengraftment period (30-100 days after HSCT), and the late postengraftment period (>100 days after HSCT). There is a distinct relationship between the patient's degree of immunodeficiency after HSCT and the incidence of various complications that may occur. Early diagnosis of CNS complications is crucial for successful management and a good prognosis, and computed tomography and magnetic resonance imaging play an important role in achieving these goals. The global increase in the use of HSCT requires radiologists to be familiar with CNS complications, their relationship to the patient's immune status, and their imaging appearances. This article describes the clinical background of HSCT; reviews the incidence, causes, and timeline of brain complications in children who underwent allogenic HSCT; and identifies the characteristic imaging findings of these disorders. ©RSNA, 2018.
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Affiliation(s)
- Mara Bonardi
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (M.B., G.S., F.Z.T.), Department of Radiology (E.T.), and Department of Pediatric Hematology Oncology (T.M., A.T.), Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Elena Turpini
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (M.B., G.S., F.Z.T.), Department of Radiology (E.T.), and Department of Pediatric Hematology Oncology (T.M., A.T.), Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Giuseppina Sanfilippo
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (M.B., G.S., F.Z.T.), Department of Radiology (E.T.), and Department of Pediatric Hematology Oncology (T.M., A.T.), Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Tommaso Mina
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (M.B., G.S., F.Z.T.), Department of Radiology (E.T.), and Department of Pediatric Hematology Oncology (T.M., A.T.), Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Alessandra Tolva
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (M.B., G.S., F.Z.T.), Department of Radiology (E.T.), and Department of Pediatric Hematology Oncology (T.M., A.T.), Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Federico Zappoli Thyrion
- From the Department of Diagnostic and Interventional Radiology and Neuroradiology (M.B., G.S., F.Z.T.), Department of Radiology (E.T.), and Department of Pediatric Hematology Oncology (T.M., A.T.), Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
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Ortigoza-Escobar JD, Alfadhel M, Molero-Luis M, Darin N, Spiegel R, de Coo IF, Gerards M, Taylor RW, Artuch R, Nashabat M, Rodríguez-Pombo P, Tabarki B, Pérez-Dueñas B. Thiamine deficiency in childhood with attention to genetic causes: Survival and outcome predictors. Ann Neurol 2017; 82:317-330. [PMID: 28856750 DOI: 10.1002/ana.24998] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 01/09/2023]
Abstract
Primary and secondary conditions leading to thiamine deficiency have overlapping features in children, presenting with acute episodes of encephalopathy, bilateral symmetric brain lesions, and high excretion of organic acids that are specific of thiamine-dependent mitochondrial enzymes, mainly lactate, alpha-ketoglutarate, and branched chain keto-acids. Undiagnosed and untreated thiamine deficiencies are often fatal or lead to severe sequelae. Herein, we describe the clinical and genetic characterization of 79 patients with inherited thiamine defects causing encephalopathy in childhood, identifying outcome predictors in patients with pathogenic SLC19A3 variants, the most common genetic etiology. We propose diagnostic criteria that will aid clinicians to establish a faster and accurate diagnosis so that early vitamin supplementation is considered. Ann Neurol 2017;82:317-330.
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Affiliation(s)
- Juan Darío Ortigoza-Escobar
- Division of Child Neurology, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Majid Alfadhel
- Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Marta Molero-Luis
- Division of Biochemistry, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ronen Spiegel
- Rappaport School of Medicine, Technion, Haifa, Israel; Department of Pediatrics B, Emek Medical Center, Afula, Israel
| | - Irenaeus F de Coo
- Department of Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Mike Gerards
- MaCSBio (Maastricht Centre for Systems Biology), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert W Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rafael Artuch
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Division of Biochemistry, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Marwan Nashabat
- Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Pilar Rodríguez-Pombo
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
- Departamento de Biología Molecular, Centro de Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular Severo Ochoa CSIC-UAM, IDIPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Brahim Tabarki
- Divisions of Pediatric Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Belén Pérez-Dueñas
- Division of Child Neurology, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
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Imaging spectrum of central nervous system complications of hematopoietic stem cell and solid organ transplantation. Neuroradiology 2017; 59:105-126. [PMID: 28255902 DOI: 10.1007/s00234-017-1804-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023]
Abstract
Neurologic complications are common after hematopoietic stem cell transplantation (HSCT) and solid organ transplantation (SOT) and affect 30-60% of transplant recipients. The aim of this article is to provide a practical imaging approach based on the timeline and etiology of CNS abnormalities, and neurologic complications related to transplantation of specific organs. The lesions will be classified based upon the interval from HSCT procedure: pre-engraftment period <30 days, early post-engraftment period 30-100 days, late post-engraftment period >100 days, and the interval from SOT procedure: postoperative phase 1-4 weeks, early posttransplant syndromes 1-6 months, late posttransplant syndromes >6 months. Further differentiation will be based on etiology: infections, drug toxicity, metabolic derangements, cerebrovascular complications, and posttransplantation malignancies. In addition, differentiation will be based on complications specific to the type of transplantation: allogeneic and autologous hematopoietic stem cells (HSC), heart, lung, kidney, pancreas, and liver. Thus, in this article we emphasize the strategic role of neuroradiology in the diagnosis and response to treatment by utilizing a methodical approach in the work up of patients with neurologic complications after transplantation.
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Ongrádi J, Ablashi DV, Yoshikawa T, Stercz B, Ogata M. Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals. J Neurovirol 2017; 23:1-19. [PMID: 27538995 PMCID: PMC5329081 DOI: 10.1007/s13365-016-0473-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/15/2016] [Accepted: 07/17/2016] [Indexed: 01/26/2023]
Abstract
The roseoloviruses, human herpesvirus (HHV)-6A, HHV-6B, and HHV-7, can cause severe encephalitis or encephalopathy. In immunocompetent children, primary HHV-6B infection is occasionally accompanied by diverse clinical forms of encephalitis. Roseolovirus coinfections with heterologous viruses and delayed primary HHV-7 infection in immunocompetent adults result in very severe neurological and generalized symptoms. Recovery from neurological sequelae is slow and sometimes incomplete. In immunocompromised patients with underlying hematological malignancies and transplantation, frequent single or simultaneous reactivation of roseoloviruses elicit severe, lethal organ dysfunctions, including damages in the limbic system, brain stem, and hippocampus. Most cases have been due to HHV-6B with HHV-6A accounting for 2-3%. The most severe manifestation of HHV-6B reactivation is post-transplantation limbic encephalitis. Seizures, cognitive problems, and abnormal EEG are common. Major risk factors for HHV-6B-associated encephalitis include unrelated cord blood cell transplantation and repeated hematopoietic stem cell transplantation. Rare genetic disorders, male gender, certain HLA constellation, and immune tolerance to replicating HHV-6 in persons carrying chromosomally integrated HHV-6 might also predispose an individual to roseolovirus-associated brain damage. At this time, little is known about the risk factors for HHV-7-associated encephalitis. Intrathecal glial cell destruction due to virus replication, overexpression of proinflammatory cytokines, and viral mimicry of chemokines all contribute to brain dysfunction. High virus load in the cerebrospinal fluid, hippocampal astrogliosis, and viral protein expression in HHV-6B-associated cases and multiple microscopic neuronal degeneration in HHV-7-associated cases are typical laboratory findings. Early empirical therapy with ganciclovir or foscarnet might save the life of a patient with roseolovirus-associated encephalitis.
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Affiliation(s)
- Joseph Ongrádi
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary.
| | - Dharam V Ablashi
- HHV-6 Foundation, 1482 East Valley Road, Santa Barbara, CA, 93101, USA
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Kotsukake-cho, Dengakugakolo, Toyoake, Aichi, 470-1192, Japan
| | - Balázs Stercz
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Masao Ogata
- Department of Medical Oncology and Hematology, Oita University Hospital, Hasama-machi, Yufu City, 879-5593, Japan
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Abstract
Early recognition and diagnosis of Wernicke encephalopathy is pivotal for the prognosis of this medical emergency, especially in patients with liver failure which predisposes individuals to develop hepatic encephalopathy. For these patients, distinguishing between hepatic encephalopathy and Wernicke encephalopathy is a challenge in real-world clinical practice.A male patient with 21-year medical history of liver cirrhosis presented diarrhea and ascites. One month before this visit, he was noted to have poor appetite and progressive fatigue. After admission, although several major symptoms, including diarrhea, ascites, hyponatremia, and hypoproteinemia, were greatly improved through appropriate treatments, his laboratory indicators were not changed much. His appetite was not reversed at discharge. On the 5th day after discharge, the patient suddenly became reluctant to speak and did not remember the recent happenings. Simultaneously, unsteady gait and strabismus occurred. On the basis of clinical manifestations and brain magnetic resonance imaging scan results, the patient was diagnosed as Wernicke encephalopathy and these relative symptoms were resolved after intravenous vitamin B1.To our knowledge, this is the second case report of Wernicke encephalopathy developing in a critically ill cirrhotic patient without hepatocellular carcinoma or operative intervention. Wernicke encephalopathy may be underdiagnosed in these patients and this case raises physicians' awareness of its possible onset.
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Affiliation(s)
- Pan Zhao
- Clinical Trial Center, Liver Failure Therapy and Research Center
- Division of Pharmacology, Institute of Infectious Diseases, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China
- Correspondence: Pan Zhao, Clinical Trial Center, Liver Failure Therapy and Research Center, Institute of Infectious Diseases, Beijing 302 Hospital (PLA 302 Hospital), No.100 of West Fourth Ring Middle Road, Beijing 100039, China (e-mail: )
| | - Yanling Zhao
- Division of Pharmacology, Institute of Infectious Diseases, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China
| | - Zhenman Wei
- Clinical Trial Center, Liver Failure Therapy and Research Center
- Division of Pharmacology, Institute of Infectious Diseases, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China
| | - Jing Chen
- Clinical Trial Center, Liver Failure Therapy and Research Center
| | - Lilong Yan
- Clinical Trial Center, Liver Failure Therapy and Research Center
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