title: Putamina involvement in Wernicke encephalopathy induced by Janus Kinase 2 inhibitor.
abstract: OBJECTIVE
  The aim of the study was to report a case of Wernicke encephalopathy (WE) due to fedratinib (Janus Kinase 2 inhibitor) treatment with atypical neuroimaging findings.
  
  
  METHODS
  We present a detailed report of the case and literature review.
  
  
  RESULTS
  A 68-year-old woman under treatment with fedratinib (investigational JAK2 inhibitor) developed memory impairment, diplopia, and ataxia compatible with WE. Brain magnetic resonance imaging showed extensive lesions involving medial thalami, periaqueductal gray, caudate nuclei, and putamina. Thiamine supplementation provided clinical recovery and radiological improvement of the lesions described. Basal ganglia lesions have been previously described in children with this disease, but this is rarely found in adults. Clinical trials including fedratinib have been recently discontinued, and its involvement in pathogenesis of WE may be related to thiamine-transporter inhibition.
  
  
  CONCLUSIONS
  Our case represents an example of drug-related WE, with a rare radiological pattern. Precocious diagnosis and treatment are essential to prevent irreversible brain injury.
authors.affiliation: Department of Neurology, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodríguez-Pardo
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Puertas-Muñoz
authors.forename: Patricia
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.forename: Javier
authors.initials: J
authors.lastname: Díaz de Terán
authors.forename: Irene
authors.initials: I
authors.lastname: Pulido-Valdeolivas
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
mesh_terms: D000368:Aged; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D005260:Female; D006801:Humans; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors*; D008279:Magnetic Resonance Imaging; D011759:Pyrrolidines / Q000008:administration & dosage / Q000009:adverse effects*; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects*; D013831:Thiamine / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome; D014899:Wernicke Encephalopathy / Q000139:chemically induced / Q000175:diagnosis* / Q000178:diet therapy / Q000473:pathology; D000096926:Benzenesulfonamides
chemical_list: D053614:Janus Kinase 2; D011759:Pyrrolidines; D013449:Sulfonamides; D013831:Thiamine; C528327:fedratinib; D000096926:Benzenesulfonamides