Cardiovascular magnetic resonance in wet beriberi
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CASE REPORT
Open Access
Cardiovascular magnetic resonance in wet beriberi Essa Essa1,2, Michael R Velez2, Sakima Smith1,2, Shivraman Giri1,2, Subha V Raman1,2 and Richard J Gumina1,2*
Abstract The clinical presentation of beriberi can be quite varied. In the extreme form, profound cardiovascular involvement leads to circulatory collapse and death. This case report is of a 72 year-old male who was admitted to the Neurology inpatient ward with progressive bilateral lower extremity weakness and parasthesia. He subsequently developed pulmonary edema and high output cardiac failure requiring intubation and blood pressure support. With the constellation of peripheral neuropathy, encephalopathy, ophthalmoplegia, unexplained heart failure, and lactic acidosis, thiamine deficiency was suspected. He was empirically initiated on thiamine replacement therapy and his thiamine level pre-therapy was found to be 23 nmol/L (Normal: 80-150 nmol/L), consistent with the diagnosis of beriberi. Cardiovascular magnetic resonance (CMR) showed severe left ventricular systolic dysfunction, markedly increased myocardial T2, and minimal late gadolinium enhancement (LGE). After 5 days of daily 100 mg IV thiamine and supportive care, the hypotension resolved and the patient was extubated and was released from the hospital 3 weeks later. Our case shows via CMR profound myocardial edema associated with wet beriberi. Background Wet Beriberi is one of four clinical syndromes associated with Thiamine (Vitamin B1) Deficiency. Other clinical syndromes include Dry Beriberi, Wernicke-Korsakoff Encephalopathy, and Leigh’s syndrome (Subacute Necrotizing Encephalomyopathy). Wet beriberi has varying degrees of cardiovascular involvement. In its most fulminant form, it is characterized by hypotension, tachycardia and lactic acidosis. If untreated, patients die within hours from circulatory collapse and pulmonary edema. This condition often goes unrecognized since it is easily confused with other illnesses. Case Presentation A 72 year-old male was admitted to the Neurology inpatient ward with progressive bilateral lower extremity weakness and parasthesia. He carried a history of type 2 diabetes and a remote history of pancreatic cancer for which he underwent Whipple procedure. Electromyography and nerve conduction studies were consistent with symmetrical distal sensorimotor polyneuropathy. As part of his evaluation, lumbar spine magnetic resonance * Correspondence: [email protected] 1 Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252 Full list of author information is available at the end of the article
imaging (MRI) demonstrated enhancement of the L4-L5 and L5-S1 disks and adjacent endplates worrisome for diskitis and/or osteomyelitis. Broad spectrum antimicrobial coverage with vancomycin and ertapenem was initiated. However, CT-guided biopsy of the lumbar spine failed to show evidence of infection or inflammation. Subsequently, the p
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