Suspected dietary-related Wernicke's encephalopathy

A 64-year-old female presented with fluctuating level of consciousness of unclear cause. She had radiological features of right middle lobe consolidation and raised inflammatory markers, but normal computed tomography scan of head and normal cerebrospinal fluid results. She was intubated and ventilated with nasogastric feeding for four days and had fully recovered after six days. Upon recovery, the patient disclosed that she had maintained an ice cream-only diet for three years prior to this presentation. She was therefore diagnosed with Wernicke's encephalopathy secondary to dietary insufficiency of thiamine, which was acutely precipitated by pneumonia and recovered following establishment of appropriate nutrition.