Celiac disease in a teenager revealed with Wernicke Encephalopathy

Article Sidebar

PDF HTML
Submitted: December 7, 2023
Published: Dec 27, 2023
DOI: 10.29328/journal.ijceo.1001054
Keywords:
Nystagmus, Bilateral sixth nerve palsy, Celiac disease, Thiamine wernicke’s encephalopathy

Main Article Content

Amira Bouayad
Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaâdi University, Tangier, Morocco
Chaimae Khodriss
Department of Ophthalmology, Mohammed 6 University Hospital of Tangier, Morocco
Sihame Tantani
Department of Pediatrics, Mohammed 5 Hospital of Tangier, Morocco
Hicham Fadel
Department of Neurology, Al Kortobi Hospital of Tangier, Morocco
Siham Alaoui Rachidi
Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaâdi University, Tangier, Morocco
Meriem Elbahloul
Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaâdi University, Tangier, Morocco

Abstract

Background: Wernicke encephalopathy is an acute neurological condition defined by a clinical triad of ophthalmoplegia, ataxia, and confusion. This disease is due to thiamine deficiency.


Case presentation: After persistent diarrhea and vomiting, a 15-year-old boy presented up-beating nystagmus, with binocular vertical diplopia and unstable gait. An etiological workup revealed a celiac disease. Magnetic resonance imaging showed bilateral periaqueductal region lesions.


Treatment and discussion: Because of suspected Wernicke’s encephalopathy, the patient was treated with thiamine replacement and significant improvement of symptoms took place. Wernicke encephalopathy is a serious medical disorder with enormous morbidity and mortality. Evaluation should include patient history with a physical and ophthalmologic examination and laboratory workup with appropriate imaging.


Conclusion: Undiagnosed celiac disease can lead to malabsorption of vitamin B1 causing acute symptoms of Wernicke encephalopathy.

Article Details

Bouayad, A., Khodriss, C., Tantani, S., Fadel, H., Rachidi, S. A., & Elbahloul, M. (2023). Celiac disease in a teenager revealed with Wernicke Encephalopathy. International Journal of Clinical and Experimental Ophthalmology, 7(2), 011–014. https://doi.org/10.29328/journal.ijceo.1001054
Case Reports

Copyright (c) 2023 Bouayad A, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Theodoreson MD, Zykaite A, Haley M, Meena S. Case of non-alcoholic Wernicke's encephalopathy. BMJ Case Rep. 2019 Nov 14;12(11):e230763. doi: 10.1136/bcr-2019-230763. PMID: 31732541; PMCID: PMC6887470.

Ota Y, Capizzano AA, Moritani T, Naganawa S, Kurokawa R, Srinivasan A. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol. 2020 Sep;38(9):809-820. doi: 10.1007/s11604-020-00989-3. Epub 2020 May 10. PMID: 32390125.

Lebwohl B, Rubio-Tapia A. Epidemiology, Presentation, and Diagnosis of Celiac Disease. Gastroenterology. 2021 Jan;160(1):63-75. doi: 10.1053/j.gastro.2020.06.098. Epub 2020 Sep 18. PMID: 32950520.

Liang H, Wu L, Liu LL, Han J, Zhu J, Jin T. A case report: Non-alcoholic Wernicke encephalopathy associated with polyneuropathy. J Int Med Res. 2017 Dec;45(6):1794-1801. doi: 10.1177/0300060517699039. Epub 2017 Apr 3. PMID: 28367669; PMCID: PMC5805199.

Hokazono K, Geminiani F, Bertholdo D. Acute up-beating nystagmus in a pregnant woman with hyperemesis gravidarum. Am J Ophthalmol Case Rep. 2017 Mar 14;6:81-83. doi: 10.1016/j.ajoc.2017.01.008. PMID: 29260066; PMCID: PMC5722145.

Fujikawa T, Sogabe Y. Wernicke encephalopathy. CMAJ. 2020 Feb 10;192(6):E143. doi: 10.1503/cmaj.190998. PMID: 32041699; PMCID: PMC7012630.

Ong C, Patel K, Musiek E, Van Stavern G. Mystery case: a young woman with isolated upbeating nystagmus. Neurology. 2015 Jan 27;84(4):e17-9. doi: 10.1212/WNL.0000000000001178. PMID: 25628435.