Wernicke's encephalopathy in a child with acute lymphoblastic leukemia.
OBJECTIVE
We describe the case of a 9-year-old boy who developed Wernicke's encephalopathy while receiving chemotherapy for acute lymphoblastic leukemia (ALL).


METHODS
After suffering anorexia for 4 weeks following chemotherapy, he exhibited nystagmus and ataxia. Symptoms rapidly worsened following an increased glucose load, and included a depressed consciousness, irregular respiration, and ophthalmoplegia. The serum thiamine level was 9 ng/ml (normal: 20-50). Cranial computed tomography (CT) revealed a low density area bilaterally at the neostriatum. Thiamine 100 mg/day was administered intravenously.


RESULTS
The patient's neurological signs improved dramatically. However, he subsequently developed pancytopenia and died of pneumonia.


CONCLUSIONS
The possibility of Wernicke's encephalopathy should be considered in children who are receiving chemotherapy for malignant disease when a persistent loss of appetite is followed by such neurological symptoms as nystagmus and ataxia.
Miyajima
Y
Y
Division of Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Japan.
Fukuda
M
M
Kojima
S
S
Matsuyama
T
T
Shylaja
N
N
Aso
K
K
D000855:Anorexia / Q000139:chemically induced; D002648:Child; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D013831:Thiamine / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014899:Wernicke Encephalopathy / Q000209:etiology*
D013831:Thiamine