A 32-year-old previously healthy white woman was admitted to the hospital with a 1-month history of poor oral intake,nausea,vomiting,dysuria,and 40-pound weight loss. The patient was diagnosed with a urinary tract infection and treated with intravenous ceftriaxone. Gastrointestinal and urinary symptoms improved with antibiotic treatment. The patient tolerated a regular diet well. However,she started complaining of severe burning pain in the legs and hands,starting distally and spreading to her hips and shoulders with marked gait instability. Physical examination was significant for proximal muscle weakness,decreased tactile and proprioceptive sensation,and hyperalgesia in a glove and stocking pattern in both upper and lower extremities. Cerebellar testing showed dysdiadochokinesia and ataxia. Deep tendon reflexes were unremarkable other than absent ankle reflexes. Electromyography and nerve conduction studies showed a length-dependent axonal sensory neuropathy. After extensive negative laboratory and radiologic investigations,the thiamine level was found to be undetectable. Intravenous thiamine treatment was started with a dose of 300 mg daily. A few hours after receiving the first dose of thiamine,the pain improved notably. Two days after starting thiamine,the patient was able to get out of bed and walk with a walker. The patient was discharged to home 3 days after starting thiamine replacement treatment. At a 1-month telephone follow-up,the patient stated that her pain and weakness continued to improve,but she still had minimal residual pain and weakness in her lower extremities and occasionally this necessitated use of a walker.
The American Journal of Medicine

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