Wernicke's Encephalopathy in Crohn's Disease: A Case Report Emphasizing Thiamine Deficiency Risk During Total Parenteral Nutrition

Abstract Vitamin B1 (thiamine) is vital for carbohydrate metabolism and neurological functions. Thiamine deficiency, often associated with alcoholism, can arise due to absorption issues, increased metabolic demand, or inadequate intake. While rare in industrialized nations, it poses a risk in conditions like Crohn's disease (CD), particularly during prolonged total parenteral nutrition (TPN) without vitamin supplementation. Wernicke's Encephalopathy (WE), a complication characterized by altered mental status, ocular signs, and ataxia, can lead to Wernicke-Korsakoff syndrome (WKS). A severely malnourished 50-year-old with CD developed WE after extended TPN without thiamine supplementation. Initial symptoms included weight loss, diarrhea, and anorexia. Despite CD treatment, TPN lacked thiamine supplementation. Neurological symptoms manifested after 15 days, with MRI confirming WE. Thiamine deficiency (40 nmol/L) was treated with 500 mg thiamine injections three times a day. Despite treatment, residual symptoms persisted, evolving into Korsakoff’s syndrome. WE diagnosis is challenging due to a variable symptom triad. WKS, primarily linked to alcohol use, is underdiagnosed in nonalcoholic patients. Patients with malabsorption or malnutrition, including CD, are at risk, especially during TPN without multivitamin injections. Thiamine deficiency leads to neurotoxicity, prompting immediate thiamine administration. MRI aids diagnosis, but treatment should not be delayed. Recommended thiamine doses vary, emphasizing individualized care. Awareness of WE in CD patients is crucial, emphasizing timely recognition, risk factor understanding, and optimized treatment strategies. Nonalcoholic WKS can be prevented through prophylactic parenteral thiamine treatment in at-risk patients. This case underscores the importance of vigilance, early intervention, and thiamine supplementation during TPN in CD, highlighting the need for tailored management approaches.