The Wrong Turn to Tijuana: Dry Beriberi after Gastric Bypass Surgery with Incidental Spinal Stenosis

Thiamine deficiency is a condition characterized by several different presentations, but one of the most devastating is dry beriberi. It is associated with polyneuropathy and muscle weakness which typically affects the lower extremities and progressively involves the upper extremities. This case outlines a case of a 41-year-old man that presented to the hospital with diffuse weakness and decreased sensation in his legs and hands over a 3-day period. The patient's medical history revealed a gastric bypass surgery 4 months previously in Tijuana, Mexico, with no follow-up, binge drinking on weekends, and emesis in the past few weeks. A physical examination revealed a significant decrease in strength in the lower extremities bilaterally as well as in the hands bilaterally. MRI showed central disc protrusion at T6-T7 that indented the spinal cord, consistent with spinal stenosis. Neurosurgery was counseled and corpectomy was recommended. While awaiting surgery, a low thiamine level resulted. Neurology was consulted, and it was recommended that high-dose IV thiamine treatment be started. An EMG study further supported the diagnosis of thiamine deficiency. The patient received high-dose IV thiamine for 2 weeks and was discharged to acute rehabilitation on a high oral dose of thiamine. While at the rehabilitation facility, the patient continued to achieve functional gains and was later discharged to a skilled nursing facility, where he continues to make progress in his activities of daily living. This case serves to remind practitioners that early recognition and treatment of thiamine deficiency is imperative, especially when other clinical evidence may point to a different diagnosis.