Wernicke's Encephalopathy during Total Parenteral Nutrition in a Child with Acute Lymphoblastic Leukemia and Acute Pancreatitis

Abstract

We herein describe a 16-year-old child with acute lymphoblastic leukemia and acute pancreatitis who developed Wernicke's encephalopathy secondary to prolonged total parenteral nutrition (TPN) that lacked vitamin B1 supplementation. The patient showed a direct and complete response to thiamine therapy. Diagnostic challenges are discussed and recommendations for prophylactic vitamin B1 supplementation in children with leukemia who are placed on TPN are made.

Wernicke's encephalopathy - leukemia - total parenteral nutrition - children - pancreatitis

References

• 1 Bleggi-Torres LF, de Medeiros BC, Werner B. et al . Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases.  Bone Marrow Transplant. 2000;  25 301-307
• 2 Brück W, Christen HJ, Lakomek H. et al . Wernicke's encephalopathy in a child with acute lymphoblastic leukemia treated with polychemotherapy.  Clin Neuropathol. 1991;  10 134-136
• 3 D’Aprile P, Tarantino A, Santoro N. et al . Wernicke's encephalopathy induced by total parenteral nutrition in patient with acute leukaemia: unusual involvement of caudate nuclei and cerebral cortex on MRI.  Neuroradiology. 2000;  42 781-783
• 4 Knoderer HM, Robarge J, Flockhart DA. Predicting asparaginase-associated pancreatitis.  Pediatr Blood Cancer. 2007;  49 634-639
• 5 Kuo SH, Debnam JM, Fuller GN. et al . Wernicke's encephalopathy: an underrecognized and reversible cause of confusional state in cancer patients.  Oncology. 2009;  76 10-18
• 6 Miyajima Y, Fukuda M, Kojima S. et al . Wernicke's encephalopathy in a child with acute lymphoblastic leukemia.  Am J Pediatr Hematol Oncol. 1993;  15 331-334
• 7 Onodera N, Nakahata T, Tanaka H. et al . Successful treatment of Wernicke's encephalopathy in a boy with acute mixed lineage leukemia.  Acta Paediatr Jpn. 1998;  40 271-274
• 8 Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management.  Lancet Neurol. 2007;  6 442-455
• 9 Shah N, Wolff JA. Thiamine deficiency: probable Wernicke's encephalopathy successfully treated in a child with acute lymphocytic leukemia.  Pediatrics. 1973;  51 750-751
• 10 Sun GH, Yang YS, Liu QS. et al . Pancreatic encephalopathy and Wernicke encephalopathy in association with acute pancreatitis: a clinical study.  World J Gastroenterol. 2006;  12 4224-4227
• 11 Vanhulle C, Dacher JN, Delangre T. et al . Antineoplastic chemotherapy and Wernicke's encephalopathy.  Arch Pediatr. 1997;  4 243-246

Correspondence