2021 Volume 38 Issue 1 Pages 48-52
A 42–year–old Japanese man was admitted to our hospital with numbness, weakness of the extremities, and gait disturbance, following watery diarrhea during long–term detention. Neurological examination revealed areflexia, muscle weakness, and hyperalgesia predominantly in the distal extremities. Nerve conduction study revealed motor and sensory axonal neuropathy. The initial diagnosis was acute motor sensory axonal neuropathy subtype of Guillain–Barré syndrome (GBS). Because of renal dysfunction and hyperkalemia, we performed immunoadsorption plasmapheresis, with the addition of hemodialysis, as immunotherapy. After completing the first treatment course, he suddenly developed dyspnea due to heart failure and went into cardiogenic shock. There was no evidence of pulmonary thrombotic embolism on chest computed tomography. During the clinical course, serum vitamin B1 level was found to be low, and he was finally diagnosed as having peripheral neuropathy and heart failure due to beriberi with vitamin B1 deficiency. The heart failure and neurological symptoms gradually resolved with vitamin administration. In this case, extracorporeal circulation induced shoshin beriberi, which is characterized by severe cardiac failure. This case highlights the need to consider beriberi as a differential diagnosis in cases with clinical manifestation suggestive of GBS.
