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(146) Wernicke-Korsakoff Syndrome in a Patient with Celiac Disease and Obsessive Compulsive Disorder: A Case Report


Authors:

Malya Sahu – Medical Student, Sidney Kimmel Medical College at Thomas Jefferson University

Marissa Beal, DO – Psychiatry resident, Thomas Jefferson University Hospital

Keira Chism, MD – Assistant Professor, Jefferson University

Madeleine Becker, MD, FACLP – Director, Graduate Medical Education, Department of Integrative Medicine
Consultation Liaison Psychiatry, Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital


Co-Authors:

Presenting Author: Malya Sahu, Sidney Kimmel Medical College at Thomas Jefferson University
Co-Author: Marissa Beal, DO, Thomas Jefferson University Hospital
Co-Author: Keira Chism, MD, Jefferson University
Co-Author: Madeleine Becker, MD, FACLP, Thomas Jefferson University Hospital

Abstract:

Background:

Wernicke-Korsakoff syndrome (WKS) is a neurological condition resulting from thiamine deficiency. While most often associated with alcohol use, various other psychiatric disorders play a role in the development of WKS and the diagnosis may be overlooked in these patients.



Case:

A 44-year-old woman with celiac disease on a gluten-free diet and unclear psychiatric history presented with acute-onset altered mental status, including disorientation, confabulations, and tangential speech. Initial lab work-up was unrevealing, including CSF studies. Further history obtained from family was notable for symptoms of obsessive compulsive disorder including obsessive behavior about gluten contamination, compulsive checking of labels leading to an increasingly restricted diet and subsequent weight loss of 60 lbs in the year prior to admission. MRI demonstrated symmetric hyperintensity of bilateral medial thalami consistent with Wernicke’s encephalopathy. Treatment with IV thiamine resulted in marked improvement of sensorium despite continued memory deficits.



Discussion:

There are few case studies citing food restriction secondary to underlying psychiatric diagnoses such as depression, schizophrenia and anorexia nervosa to be associated with WKS (Dias, 2017; Tsai, 2004; Oudman, 2018). We present a unique case of a patient with celiac disease and a co-occurring diagnosis of OCD. An exacerbation of her underlying symptoms of OCD led to increased paranoia and restriction of food, causing weight loss, malnutrition, and subsequent development of WKS. The initial cause of her encephalopathy was unclear, but thorough history taking and exam helped to obtain a diagnosis. Treatment with IV thiamine can prevent long term neurologic deficits so it is essential to diagnose and treat promptly. It is important to be aware of the potential for thiamine deficiency in patients with psychiatric illness to reduce long term deficits.



Conclusion:

This case highlights WKS in a patient with celiac disease and a severely restricted diet secondary to symptoms of OCD. It is important to include WKS on the differential for encephalopathic patients who have a restricted diet and an underlying psychiatric diagnosis and gather robust collateral history to ensure timely diagnosis and treatment within this vulnerable patient population. Treatment is low risk with IV thiamine, effective in reversing the neurological symptoms, and can prevent progression to permanent cognitive deficits and mortality if diagnosed quickly.


References:

Dias, S P. (2017). Wernicke’s Encephalopathy Due to Food Refusal in a Patient with Severe Depressive Disorder. Journal of the Neurological Sciences, 375: 92–93.


Oudman, E. (2018). Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review. Psychiatry and Clinical Neurosciences, 72(10): 774-779.

Tsai, H. Y., Yeh, T. L., Wang, S. M., Chen, P. S., & Yang, Y. K. (2004). Starvation‚Äźinduced Wernicke's encephalopathy in schizophrenia. Psychiatry and Clinical Neurosciences, 58(3): 338-339.

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