Wernicke Encephalopathy in a Child With Acute Lymphoblastic Leukemia: A Case Report
Ghazaleh Shakibamaram1, Mohammadreza Dolikhani1, Farideh Moussavi2
1Medical School of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Wernicke encephalopathy (WE) is a severe neurological condition due to thiamine deficiency. Early recognition and thiamine therapy are crucial, especially in pediatric cancer patients, to prevent irreversible damage or death.
Area of Science:
- Neurology
- Pediatric Oncology
- Nutritional Neuroscience
Background:
- Wernicke encephalopathy (WE), a critical neurological condition from thiamine deficiency, is often linked to alcoholism but also affects malnourished pediatric cancer patients.
- WE is frequently underdiagnosed in children, with diagnoses often made postmortem.
- This case details a 6-year-old girl with acute lymphoblastic leukemia (ALL) who developed WE due to persistent, treatment-resistant nausea and vomiting.
Observation:
- The patient exhibited gait disturbance, ophthalmoparesis, and paraparesis following significant weight loss and vomiting.
- Initial assessments suggested alternative diagnoses like cerebellitis and Guillain-Barré Syndrome.
- Progressive neurological decline and MRI findings of specific brain lesions confirmed WE, despite initial diagnostic challenges.
Findings:
- Delayed diagnosis of WE in this pediatric leukemia patient led to partial symptom recovery after thiamine treatment.
- The patient unfortunately developed lymphomatous meningitis and sepsis, succumbing to complications.
- Overlapping symptoms with other neurological disorders contributed to diagnostic delays.
Implications:
- Early clinical suspicion of WE in pediatric leukemia patients with vomiting is vital for timely thiamine intervention.
- Heightened awareness of thiamine deficiency in pediatric oncology is necessary.
- Prophylactic thiamine supplementation should be considered for high-risk pediatric cancer patients.
Background:
Wernicke encephalopathy (WE) is a life-threatening neurological disorder caused by thiamine deficiency, commonly associated with alcoholism but also observed in malnourished pediatric cancer patients undergoing intensive chemotherapy. WE remains underdiagnosed in children, with many cases only confirmed postmortem. We report a 6-year-old girl with acute lymphoblastic leukemia (ALL) who developed WE secondary to treatment-resistant nausea and vomiting.
Case:
The patient presented with acute gait disturbance, ophthalmoparesis, and paraparesis following persistent vomiting and significant weight loss. Initial diagnostic evaluations, including cerebrospinal fluid analysis and neuroimaging, suggested alternative diagnoses such as cerebellitis and Guillain-Barré Syndrome. However, progressive neurological deterioration, the emergence of encephalopathy, and follow-up magnetic resonance imaging (MRI) findings of hyperintense lesions in the periventricular, periaqueductal, and cerebellar regions supported the diagnosis of WE. The overlapping features with other neurological conditions contributed to a delay in recognizing WE and initiating thiamine therapy. Despite initiating high-dose intravenous thiamine, symptom resolution was significant but partial. Unfortunately, the patient later developed lymphomatous meningitis and sepsis and ultimately succumbed to complications.
Conclusion:
This case highlights the importance of early clinical recognition of WE in pediatric leukemia patients with prolonged vomiting, as delayed diagnosis can lead to irreversible neurological damage or death. Given the limitations of early neuroimaging findings, clinical suspicion should prompt immediate thiamine supplementation. The report points out the need for heightened awareness of thiamine deficiency in pediatric oncology, emphasizing the role of prophylactic supplementation in high-risk patients.
