title: Shoshin beriberi induced by long-term administration of diuretics: a case report.
abstract: Previous studies have suggested that diuretic therapy for heart failure may lead to thiamine deficiency due to the increased urinary thiamine excretion. Herein, we present the case of a 61-year-old man with shoshin beriberi, a fulminant form of wet beriberi, induced by long-term diuretic therapy. The patient had a history of heart failure with preserved ejection fraction and was receiving furosemide and trichlormethiazide therapy. He presented with worsening exertional dyspnea and was admitted for heart failure exacerbation. His condition failed to improve even after intensive treatment. A hemodynamic evaluation with the Swan-Ganz catheter revealed high-output heart failure with low peripheral vascular resistance. Thiamine was administered for suspected shoshin beriberi; his hemodynamic status improved dramatically within the next six hours. The serum thiamine level was below the normal range; the patient was therefore diagnosed with shoshin beriberi. The common causes of thiamine deficiency were not identified. Long-term diuretic therapy with furosemide and thiazide was thought to have played a major role in the development of thiamine deficiency. This case illustrates the importance of considering wet beriberi as a possible cause of heart failure exacerbation in patients taking diuretics, even when the common thiamine deficiency causes are not identified with history-taking.
authors.affiliation: Department of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota 471-8513, Japan ; Department of Medicine, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota 471-8513, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Umeda
authors.affiliation: Department of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota 471-8513, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Iwase
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