Stem Cell Transplant-Associated Wernicke Encephalopathy in a Patient with High-Risk Neuroblastoma

Area of Science:

• Pediatric Oncology
• Neuroscience
• Nutritional Science

Background:

• Children with high-risk neuroblastoma often require intensive treatments, including chemotherapy and stem cell transplantation.
• Total parenteral nutrition (TPN) is crucial for nutritional support but can sometimes lead to micronutrient deficiencies.
• Hypersensitivity reactions may necessitate the removal of vitamin formulations from TPN.

Observation:

• A 5-year-old patient with stage 4 neuroblastoma developed altered mental status, ataxia, and tachycardia during treatment.
• Clinical presentation and brain MRI findings were indicative of thiamine (vitamin B1) deficiency and Wernicke encephalopathy.
• Skin findings were also noted, consistent with vitamin B1 deficiency.

Findings:

• Rapid and complete reversal of neurological and skin symptoms was observed following vitamin B1 administration.
• This suggests a direct causal link between thiamine deficiency and the observed clinical manifestations.
• The patient's condition improved dramatically with targeted micronutrient repletion.

Implications:

• Highlights the critical need for vigilant micronutrient monitoring in pediatric cancer patients undergoing intensive therapy.
• Emphasizes the potential for severe neurological complications due to vitamin deficiencies during TPN.
• Underscores the importance of individualized nutritional management in pediatric oncology to prevent adverse events.