Abstract
Despite the fact that both thiamine deficiency (TD) and Wernicke encephalopathy (WE) have been observed to some degree in cancer patients, such cases of TD and/or WE reported to date have all been diagnosed after the initiation of treatment. We here report a case of TD that presented without the commonly accepted triad of WE symptoms based on a total nutritional evaluation prior to the onset of treatment for cancer. The patient was a 71-year-old man with esophageal cancer who was referred to the oncology outpatient clinic for evaluation to determine the treatment plan. Although he did not present with delirium, cerebellar signs, or ocular symptoms, TD was suspected based on a reduction in appetite lasting 2 months as thiamine stores in the body are depleted in as few as 18 days. Blood findings showed a marked decline in serum thiamine level supported, which the diagnosis of TD. This case revealed the existence of a cancer patient with subclinical TD prior to the onset of treatment for cancer. Due to the fact that TD can occur without the characteristic symptoms as in this case, we believe it is important that total nutritional evaluation of cancer patients always be considered.
Highlights
The biologically active form of thiamine is known to be essential to oxidative cellular metabolism [1]
thiamine deficiency (TD) and Wernicke encephalopathy (WE) have been reported in a significant number of cancer patients [2, 7, 10], with its clinical onset considered to be associated with the treatment [4]
The suspicion of TD in this patient was due to a total evaluation of nutritional status, such as decreased food intake reported by the patient, objective information such as weight loss, and the excess consumption of thiamine due to the rapid growth of the tumor
Summary
The biologically active form of thiamine (thiamine pyrophosphate) is known to be essential to oxidative cellular metabolism [1]. He had had epigastric pain for half a year and had experienced swallowing difficulty as well as vomiting for a month before admission He was diagnosed with esophageal cancer at another hospital he had previously visited. At the first visit to our institution, he showed no mental status changes or neurological abnormalities, with a blood pressure of 126/78 mmHg and pulse of 77/min He advised staff that his appetite had been reduced to 1/3 that of normal from 2 months previously, and his weight had decreased from 58 to 50 kg over the previous 2 months. Thereafter, vitamin B1 was included in any infusions deemed necessary One week after his visit to the Oncology Clinic, he underwent two cycles of neoadjuvant chemotherapy using cisplatin and fluorouracil, followed 2 months by esophagectomy without complication. The serum thiamine levels just before and after the adjuvant chemotherapy were 32 and 32 ng/mL, respectively
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