Vidor Marco, Wirdasari Wirdasari, Muzellina Virly Nanda, Salim Simon
Faculty of Medicine University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
Division of Cardiovascular, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Acta Med Indones. 2025 Apr;57(2):251-256.
Poorly controlled Crohn's disease is associated with several complications, including malabsorption of vitamins and minerals such as vitamin D, vitamin B12, and vitamin B1 (thiamine). Thiamine, among other vitamins, plays a crucial role in Adenosine Triphosphate formation as well as nerve propagation. Thiamine deficiency initially manifests as wet or dry beriberi but may lead to the devastating Wernicke-Korsakoff syndrome. In this report, we present a case of full-blown Wernicke encephalopathy associated with uncontrolled Crohn's disease. An 18-year-old young man was admitted with a chief complaint of hematemesis for 2 weeks before admission. He was previously diagnosed with Crohn's disease in the past year, with constipation as the predominant symptom, and has been taking mesalazine 500 mg twice daily. Esophagogastroduodenoscopy and colonoscopy re-evaluation showed a worsening picture of Crohn's disease pangastritis. The patient experienced swelling in both legs, the scrotum, and the upper extremities during hospital admission. On day 14 of hospitalization, the patient fell into a state of confusion with visual and auditory hallucinations, ophthalmoplegia, and ataxia. A Brain MRI showed a typical picture of Wernicke encephalopathy. Intravenous thiamine was administered, and the patient regained consciousness. His clinical symptoms improved every day until he was discharged. Uncontrolled Crohn's disease may have several complications that clinicians need to be aware of, including thiamine deficiency. Wernicke encephalopathy shows a devastating clinical picture, but with thiamine therapy, it may resolve before further deterioration leads to irreversible Korsakoff syndrome.
克罗恩病控制不佳会引发多种并发症，包括维生素和矿物质吸收不良，如维生素D、维生素B12和维生素B1（硫胺素）。硫胺素与其他维生素一样，在三磷酸腺苷形成以及神经传导中发挥着关键作用。硫胺素缺乏最初表现为湿性或干性脚气病，但可能会导致严重的韦尼克-科尔萨科夫综合征。在本报告中，我们呈现了一例与未控制的克罗恩病相关的典型韦尼克脑病病例。一名18岁青年男性因入院前2周呕血为主诉入院。他在去年被诊断为克罗恩病，以便秘为主要症状，一直每日两次服用500毫克美沙拉嗪。食管胃十二指肠镜和结肠镜重新评估显示克罗恩病合并全胃炎病情恶化。患者在住院期间出现双腿、阴囊和上肢肿胀。住院第14天，患者陷入意识模糊，伴有视幻觉和听幻觉、眼肌麻痹及共济失调。脑部磁共振成像显示典型的韦尼克脑病表现。给予静脉注射硫胺素后，患者恢复意识。其临床症状每日改善，直至出院。未控制的克罗恩病可能有多种并发症，临床医生需要予以关注，包括硫胺素缺乏。韦尼克脑病呈现出严重的临床表现，但通过硫胺素治疗，在进一步恶化导致不可逆的科尔萨科夫综合征之前可能会得到缓解。
