An Interesting Case of Wernicke's Encephalopathy in Co-Existence With Tropical Infections: A Case Report

Wernicke's encephalopathy (WE) is an acute neurological disorder arising from thiamine (vitamin B1) deficiency, characterized by a classic triad of ophthalmoplegia, ataxia, and altered mental status. While it is more common in males, it can occur in various contexts, including pregnancy. Leptospirosis, a zoonotic infection, can co-occur with other illnesses such as scrub typhus. We present a case of a 27-year-old primigravida in her second trimester who developed WE, presenting with altered sensorium, fever, and neurological deficits. Initial examination revealed ophthalmoplegia and confusion, with MRI confirming typical findings of WE. Investigations indicated co-infection with leptospirosis and scrub typhus, along with abnormal liver function tests. Treatment with intravenous thiamine resulted in symptomatic improvement. This case underscores the critical role of early diagnosis and treatment of WE, especially in pregnant patients with poor nutritional intake or hyperemesis gravidarum. Imaging studies, particularly MRI, enhance diagnostic accuracy. The patient's condition was exacerbated by concurrent infections affecting liver function and thiamine reserves. WE, though rare in pregnancy, should be suspected in cases of nutritional deficiency and acute illness. Prompt recognition and thiamine supplementation are essential to prevent severe complications, including motor deficits and mortality.