Non-Alcohol-Related Wernicke Encephalopathy

A 39-year-old male with a recent diagnosis of human immunodeficiency virus infection, in the AIDS stage, and Burkitt lymphoma, both identified in the context of a constitutional syndrome with six months of evolution developed an acute condition with psychomotor slowing, disorientation, and gait imbalance, six weeks after initiating antiretroviral therapy and chemotherapy. Neurological examination revealed multidirectional nystagmus, length-dependent sensory disturbance, and severe appendicular and gait ataxia. Brain MRI showed symmetrical hyperintensity in the medial thalami, extending to the posterior midbrain, pons, and medulla. With a clinical suspicion of Wernicke’s encephalopathy, high-dose intravenous thiamine supplementation was initiated, resulting in rapid clinical improvement and imaging regression of the lesions. This case highlights an atypical and potentially reversible presentation of Wernicke’s encephalopathy, underscoring the importance of clinical suspicion in patients with severe cachexia, hematologic malignancies, or other conditions that impair thiamine absorption.