Nutritional Myeloneuropathy Secondary to Thiamine Deficiency: A Case Report

Thiamine (vitamin B1) deficiency can occur secondary to malnutrition, which is associated with multiple etiologies, from imbalanced dietary habits to significant gastrointestinal nutritional losses such as recurrent vomiting or diarrhea. Thiamine deficiency manifests as dry or wet beriberi, Wernicke encephalopathy, or Korsakoff syndrome. We present a 26-year-old lady, three months post-laparoscopic sleeve gastrectomy with a complicated postoperative course due to poor oral intake and recurrent vomiting, who presented with bilateral limb weakness and vision loss of five days duration. Physical examination was significant for decreased power strength in her lower limbs relative to the upper limbs, and absent reflexes in her lower limbs. She was extensively tested for different disease-causing neuropathies, including lumbar puncture, imaging studies of the brain and spine regions, nerve conduction studies, and autoimmune disorders. Investigations revealed significantly low thiamine levels compared to other vitamins and minerals. She was managed with vitamin supplementation and aggressive physiotherapy. This case emphasizes the importance of considering nutritional deficiencies as a differential diagnosis for neuropathies, especially with certain risk factors such as poor nutritional intake or gastrointestinal operations or losses.