451 - Dry Beriberi as a Sequelae of Thiamine Deficiency in a 42-Year-Old with Chronic Alcohol Use Disorder and Gastric Bypass Surgery: A Case Report

Case Diagnosis: Metabolic encephalopathy and polyneuropathy 2/2 to dry beriberi disease

Case Description: Patient is a 42-year-old male with PMHx of gastric bypass surgery and chronic alcohol use disorder (AUD) who presented with progressive ascending paresthesias post-upper respiratory infection. Initially, he experienced numbness in his bilateral lower extremities with progression to his mid-thoracic region (T4) with ataxia and altered mental status. Neurology initially suspected Guillain-Barre syndrome (GBS) and initiated empiric treatment with IVIG and corticosteroids. Brain MRI discovered mammillary body hyperintensities indicative of thiamine deficiency, prompting treatment with methylprednisolone and IV thiamine which improved patient's mentation and polyneuropathy. The patient was transferred to acute inpatient rehabilitation, continuing with a prednisone taper and oral thiamine. Electrodiagnostic studies showed length-dependent symmetric sensorimotor polyneuropathy with significant axonal/segmental myelin involvement. Upon discharge, the patient showed gradual improvements in mentation and paresthesias, but cognitive function remained below baseline

Discussions: Thiamine plays a critical role in glucose metabolism and neuronal function. Deficiency of thiamine can result in clinical manifestations including cardiovascular and neurological abnormalities, leading to wet and dry beriberi, respectively. This case report examines the unique coexistence of chronic AUD and gastric bypass surgery as risk factors for development of dry beriberi. Patient was initially treated for GBS before brain MRI findings helped redirect and narrow the diagnosis to dry beriberi. This case highlights the clinical complexity and diagnostic challenges associated with this condition. It stresses the importance of assessing comorbidities, early diagnosis, intervention, and rehabilitation strategies for patients experiencing thiamine deficiency and dry beriberi.

Conclusions: The convergence of chronic AUD and gastric bypass surgery in this patient’s history presents a unique interplay of risk factors and physiological mechanisms that increased the risk for developing thiamine deficiency and dry beriberi. Clinicians should be cognizant of thiamine deficiency in such patients, given the potential for severe neurological and systemic complications.