title: Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy.
abstract: Few reports of Wernicke encephalopathy in oncological settings have been published. Some cases of Wernicke encephalopathy are related to appetite loss; however, the degree to which loss of appetite leads to thiamine deficiency is not known.
  
  
  
  A 63-year-old female with advanced cancer of the external genitalia was referred for psychiatric consultation because of disorientation, insomnia, and bizarre behaviors. Her symptoms fulfilled the diagnostic criteria for delirium. Routine laboratory examinations did not reveal the cause of the delirium. Thiamine deficiency was suspected because appetite loss had continued for 19 days since she had been admitted to hospital.
  
  
  
  Intravenous administration of thiamine resulted in recovery from the delirium within three days. Serum thiamine level was found to be 16 ng/ml (normal range: 24-66 ng/ml). The clinical findings, the low level of thiamine in the serum, and the effective alleviation of delirious symptoms after thiamine administration fulfilled Francis's criteria for delirium induced by thiamine deficiency.
  
  
  
  Clinicians must be aware of the possibility of Wernicke encephalopathy in cancer patients, especially in those with loss of appetite for longer than 18 days. The degree of appetite loss in such patients might serve as a reference. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.
authors.affiliation: Department of Psycho-Oncology,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Onishi
authors.affiliation: Department of Psycho-Oncology,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ishida
authors.affiliation: Department of Psycho-Oncology,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Toyama
authors.affiliation: Department of Psycho-Oncology,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Iori
authors.initials: I
authors.lastname: Tanahashi
authors.affiliation: Department of Laboratory Medicine,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ikebuchi
authors.affiliation: Department of Laboratory Medicine,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Taji
authors.affiliation: Department of Gynecologic Oncology,Saitama Medical University Saitama International Medical Center,Saitama,Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.affiliation: Department of Psychiatry and Cognitive Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Nagoya,Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
mesh_terms: D003693:Delirium / Q000150:complications / Q000209:etiology; D004358:Drug Therapy; D001068:Feeding and Eating Disorders / Q000150:complications; D005260:Female; D006801:Humans; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000209:etiology; D013831:Thiamine / Q000494:pharmacology / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000150:complications*; D014565:Urogenital Neoplasms / Q000150:complications* / Q000601:surgery; D014899:Wernicke Encephalopathy / Q000150:complications / Q000175:diagnosis*
chemical_list: D013831:Thiamine
keywords: Cancer; Delirium; Thiamine deficiency; Wernicke encephalopathy