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Wernicke's encephalopathy in a child with acute lymphoblastic leukemia treated with polychemotherapy
W Brück1, H J Christen, H Lakomek
1Department of Neuropathology, University of Göttingen, Germany.
Insights
This case study highlights a child with acute lymphoblastic leukemia who developed Wernicke
Area of Science:
- Pediatric Oncology
- Neurology
- Nutritional Science
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Polychemotherapy is a standard treatment for ALL, aiming for tumor remission.
- Parenteral nutrition may be required in patients experiencing severe treatment side effects.
Observation:
- A 3 3/4-year-old girl with ALL achieved remission after polychemotherapy.
- Six months post-treatment initiation, she experienced vomiting and diarrhea, requiring parenteral nutrition.
- Ocular movement disturbances manifested four weeks after gastrointestinal symptoms.
Findings:
- The patient tragically died suddenly three days after the onset of ocular disturbances.
- Autopsy confirmed Wernicke's encephalopathy as the cause of death.
- This suggests a potential link between chemotherapy, parenteral nutrition, and thiamine deficiency.
Implications:
- This case underscores the critical need for thiamine (vitamin B1) supplementation in pediatric patients undergoing intensive cancer treatment.
- Early recognition and management of potential Wernicke's encephalopathy are crucial in this vulnerable population.
- Further research into optimal nutritional support during pediatric cancer therapy is warranted.
Abstract:
We report on a 3 3/4-year-old girl with acute lymphoblastic leukemia. Polychemotherapy caused a complete remission of the tumor. Six months after treatment was started, the patient developed vomiting and diarrhea necessitating parenteral nutrition. Disturbance of eye movements appeared 4 weeks later. The patient died suddenly 3 days after their manifestation. Autopsy revealed Wernicke's encephalopathy. This case demonstrates the need for thiamine substitution in infants with malignant diseases.