Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8432
Peer-review started: October 23, 2017
First decision: November 8, 2017
Revised: November 22, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 21, 2017
A 45-year-old male patient received liver transplantation due to decompensatory cirrhosis because of hepatitis B and developed Wernicke encephalopathy on the 15th postoperative day.
The patient became irritable, raving and lethargic, and appeared to gradually develop unclear enunciation, difficulty in grasping objects, and memory loss.
Hepatic encephalopathy and adverse effects of anti-rejection drugs.
Thiamine plasma level was not tested, while the other laboratory results were close to normal.
Brain magnetic resonance imaging showed symmetrical high T1 and T2 signal intensities in thalamus and pons and high signal intensities of T2 Flair in the paraventricular area.
No pathological examination was performed.
Intravenous vitamin B1 at 500 mg daily for 1 wk and 3 compound vitamin B tablets orally 3 times daily for 3 mo.
Only 2 other cases of Wernicke encephalopathy after liver transplantation have been reported, and there have been case reports of Wernicke encephalopathy in bone marrow transplantation.
Wernicke encephalopathy is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism.
We should pay more attention to Wernicke encephalopathy after liver transplantation to avoid delaying treatment. Patients who had poor nutrition preoperation or who needed a long fasting duration postoperation should receive intravenous vitamin B1 at 100 mg daily until return to their normal diet.