Gastrointestinal Beriberi Mimicking a Surgical Emergency in a Well-Nourished Patient: A Case Report

Beriberi is a well-documented disease caused by thiamine deficiency. The diagnosis of gastrointestinal beriberi in the clinical setting is uncommon, especially in nonalcoholic patients. Failure to recognize beriberi can result in devastating acute multisystem organ failure; however, timely treatment can result in rapid improvement in a patient's clinical status. We present the case of an 81-year-old nonalcoholic man presenting with abdominal pain, lethargy, and hypotension. The patient was admitted to the intensive care unit and intubated for hemodynamic instability and declining mental status. Further investigations revealed profound lactic acidosis and cardiac hypokinesis. The patient's course changed rapidly after intravenous thiamine administration, and within hours he was weaned off vasopressors. He was extubated, discharged from the intensive care unit, and discharged to home quickly thereafter. To our knowledge, this report is the first description of gastrointestinal beriberi mimicking a surgical emergency in an otherwise well-nourished patient with no history of alcoholism. The rapid improvement the patient experienced with administration of thiamine underscores the importance of considering gastrointestinal beriberi and thiamine deficiency in all moribund patients with unexplained abdominal symptoms, cardiogenic shock, and lactic acidosis.