Xie B, Si ZZ, Tang WT, Qi HZ, Li T. Wernicke encephalopathy in a patient after liver transplantation: A case report. World J Gastroenterol 2017; 23(47): 8432-8436 [PMID: 29308003 DOI: 10.3748/wjg.v23.i47.8432]
Corresponding Author of This Article
Ting Li, MD, PhD, Associate Research Scientist, Surgeon, Organ Transplantation Center, The Second Xiang-ya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha 410011, Hunan Province, China. liting001@csu.edu.cn
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 21, 2017; 23(47): 8432-8436 Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8432
Wernicke encephalopathy in a patient after liver transplantation: A case report
Bin Xie, Zhong-Zhou Si, Wei-Ting Tang, Hai-Zhi Qi, Ting Li
Bin Xie, Zhong-Zhou Si, Hai-Zhi Qi, Ting Li, Organ Transplantation Center, The Second Xiang-ya Hospital, Central South University, Changsha 410011, Hunan Province, China
Wei-Ting Tang, Department of Neurology, Xiang-ya Hospital, Central South University, Changsha 410008, Hunan Province, China
Author contributions: Xie B designed the study and wrote the manuscript; Si ZZ and Li T performed the operation; Xie B and Tang WT collected the clinical data; Qi HZ and Li T were involved in editing of the manuscript and provided financial support.
Supported by National Natural Science Foundation of China, No. 81200326; Natural Science Foundation of Hunan Province, No. 2016JJ3165.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ting Li, MD, PhD, Associate Research Scientist, Surgeon, Organ Transplantation Center, The Second Xiang-ya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha 410011, Hunan Province, China. liting001@csu.edu.cn
Telephone: +86-731-85295808 Fax: +86-731-85295808
Received: October 20, 2017 Peer-review started: October 23, 2017 First decision: November 8, 2017 Revised: November 22, 2017 Accepted: November 27, 2017 Article in press: November 27, 2017 Published online: December 21, 2017 Processing time: 61 Days and 1.7 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A 45-year-old male patient received liver transplantation due to decompensatory cirrhosis because of hepatitis B and developed Wernicke encephalopathy on the 15th postoperative day.
Clinical diagnosis
The patient became irritable, raving and lethargic, and appeared to gradually develop unclear enunciation, difficulty in grasping objects, and memory loss.
Differential diagnosis
Hepatic encephalopathy and adverse effects of anti-rejection drugs.
Laboratory diagnosis
Thiamine plasma level was not tested, while the other laboratory results were close to normal.
Imaging diagnosis
Brain magnetic resonance imaging showed symmetrical high T1 and T2 signal intensities in thalamus and pons and high signal intensities of T2 Flair in the paraventricular area.
Pathological diagnosis
No pathological examination was performed.
Treatment
Intravenous vitamin B1 at 500 mg daily for 1 wk and 3 compound vitamin B tablets orally 3 times daily for 3 mo.
Related reports
Only 2 other cases of Wernicke encephalopathy after liver transplantation have been reported, and there have been case reports of Wernicke encephalopathy in bone marrow transplantation.
Term explanation
Wernicke encephalopathy is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism.
Experiences and lessons
We should pay more attention to Wernicke encephalopathy after liver transplantation to avoid delaying treatment. Patients who had poor nutrition preoperation or who needed a long fasting duration postoperation should receive intravenous vitamin B1 at 100 mg daily until return to their normal diet.
