Thiamine deficiency: a cause of profound hypotension and hypothermia after plastic surgery

A 72-year-old woman became profoundly hypotensive and hypothermic 10 hours after undergoing a panniculectomy. She remained critically ill despite aggressive intensive care, and a diagnosis was not identified despite multiple consultations, imaging, and exploratory laparatomy. No improvement was seen until a large dose of intravenous thiamine alone was administered, dramatically restoring a normotensive and normothermic state. Although few cases of thiamine deficiency have been described in the context of plastic and reconstructive surgery, this case emphasizes the importance of considering this potentially fatal condition, which often does not manifest classically in the early postoperative period.