From Starvation to Neurological Crisis: A Case of Wernicke's Encephalopathy Triggered by Laxative Abuse

Wernicke's encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine deficiency, most commonly associated with chronic alcohol use, but it can also arise from rare nonalcoholic etiologies such as anorexia nervosa. This report describes a case of WE in a 56-year-old female patient with anorexia nervosa and chronic laxative misuse, presenting with altered mental status, disorientation, visual disturbances, and ataxia. Clinical evaluation revealed severe malnutrition (BMI 15.0 kg/m²) and multiple electrolyte abnormalities, while MRI findings demonstrated signal abnormalities in the bilateral medial thalamic and periaqueductal gray matter, consistent with WE. Chronic laxative abuse exacerbated thiamine depletion, leading to the development of WE. The patient was treated with high-dose intravenous thiamine and nutritional rehabilitation, resulting in complete recovery of neurological function within five days. This case emphasizes the importance of considering WE in malnourished patients presenting with encephalopathy, even in the absence of alcohol use, and highlights the critical role of early diagnosis, prompt thiamine replacement, and nutritional support in preventing irreversible neurological damage and ensuring recovery.