Severe Lactic Acidosis, Wernicke’s Encephalopathy, and Wet Beriberi Due to Thiamine Deficiency in a Child With Leukemia

Introduction

Thiamine (vitamin B1), which is a water-soluble vitamin, might lead to Wernicke’s encephalopathy (WE), wet beriberi, dry beriberi, and lactic acidosis when its serum concentration decreases (Polegato BF et al., Nutr Clin Pract 2019; 34: 558–564). WE is an acute syndrome that requires emergency treatment to prevent neurologic morbidity and death (Park SW et al., Korean J Pediatr 2014; 57: 496–499). It is rare in children and is characterized by the typical triad of ophthalmoplegia, ataxia, and confusion. Although most often associated with alcoholism, WE also occurs in the setting of prolonged parenteral nutrition without vitamin supplementation, prolonged starvation or unbalanced nutrition, gastric by-pass surgery, cancer treatment in pediatric patients, and transplantation (Arslan EA et al., Pediatr Neurol 2014; 51: 840–842, Parkin AJ et al., Brain Cogn 1991; 15:69–82). Thiamine deficiency (TD) can also lead to cardiovascular dysfunction called “wet beriberi,” which is characterized by tachycardia and hypotension (Long L et al., Am J Case Rep 2014; 15:52–55). Presumptive treatment should be initiated immediately if the presence of risk factors raises suspicion of this condition because there is no rapid diagnostic test for thiamine deficiency (Yin H et al., J Int Med Res 2019; 47: 4886–4894). In a systematic review, 110 papers covering 389 pediatric patients under the age of 19 with confirmed TD in high-income countries were documented. There were 22 (5%) malignancy patients with TD among the 389 pediatric cases (including leukemia and neuroblastoma). Hyperlactatemia was the most recognized finding in these individuals. Methotrexate and metronidazole use was linked to TD in three pediatric cases with cancer (Rakotoambinina B et al., Ann N Y Acad Sci 2021; 1498: 57–76). However, none of them showed concomitant clinical symptoms such as WE, severe lactic acidosis, and wet beriberi, in patients with TD. The objective of this report was to present a small child with Acute myeloid leukemia (AML ) who developed and recovered from severe lactic acidosis, encephalopathy, and heart failure during the neutropenic period following thiamine replacement.

Publication History

Article published online:
14 December 2023