A case of Marchiafava-Bignami disease complicated with necrotizing fasciitis

Abstract

Marchiafava-Bignami disease (MBD) primarily occurs in individuals who chronically consume alcohol. It is characterized by demyelination of the corpus callosum due to thiamine (vitamin B1) deficiency, similar to the changes observed in Wernicke's encephalopathy. A 56-year-old man with a history of diabetic foot ulcers experienced disturbed consciousness and was referred from a local hospital. Upon arrival, the patient was in a comatose state (Glasgow coma scale score: 3), with a blood pressure of 140/66 mmHg (with continuous noradrenaline administration at 0.08 μg/kg/min), heart rate of 118 beats/min, and body temperature of 37.9°C. His right lower limb was necrotic, consistent with necrotizing fasciitis, and computed tomography revealed gas formation. Owing to the patient's history of alcohol abuse, we administered vitamin B1 intravenously. The patient underwent emergency right thigh amputation. However, his disturbed consciousness persisted after surgery, and T2-weighted magnetic resonance image of the brain showed a high intensity on the left side of the corpus callosum and swelling, which confirmed a diagnosis of MBD. The patient gradually regained consciousness and was transferred to the previous hospital on day 37.