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Wernicke's encephalopathy in a child with acute lymphoblastic leukemia
Y Miyajima1, M Fukuda, S Kojima
1Division of Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Japan.
Purpose:
We describe the case of a 9-year-old boy who developed Wernicke's encephalopathy while receiving chemotherapy for acute lymphoblastic leukemia (ALL).
Patients And Methods:
After suffering anorexia for 4 weeks following chemotherapy, he exhibited nystagmus and ataxia. Symptoms rapidly worsened following an increased glucose load, and included a depressed consciousness, irregular respiration, and ophthalmoplegia. The serum thiamine level was 9 ng/ml (normal: 20-50). Cranial computed tomography (CT) revealed a low density area bilaterally at the neostriatum. Thiamine 100 mg/day was administered intravenously.
Results:
The patient's neurological signs improved dramatically. However, he subsequently developed pancytopenia and died of pneumonia.
Conclusion:
The possibility of Wernicke's encephalopathy should be considered in children who are receiving chemotherapy for malignant disease when a persistent loss of appetite is followed by such neurological symptoms as nystagmus and ataxia.