An Atypical Case of Marchiafava-Bignami Disease in a Young Chronic Alcoholic: Challenges in Diagnosis and Prognosis

A 27-year-old male patient with chronic alcohol use disorder was diagnosed with Marchiafava-Bignami disease (MBD) after experiencing an episode of unconsciousness. MRI scans revealed lesions in the corpus callosum and adjacent white matter. Despite prompt initiation of intensive treatment with high-dose thiamine and corticosteroids, the patient only partially recovered, remaining disoriented and exhibiting persistent neurological deficits during follow-up. MBD is a rare condition seen in individuals with chronic alcohol use disorder and malnutrition, often resulting in unfavorable outcomes despite prompt intervention. This case underscores the impact of the patient's young age at the onset of alcohol dependence, a low Glasgow Coma Scale score, and the presence of extracallosal lesions on his overall prognosis. We discuss the pathophysiology, presentation, and treatment. We also describe the role of each prognostic factor of MBD in an unfavourable outcome highlighting the need for a larger study to define various prognostic indicators at presentation and identify appropriate treatment approaches.