Howard et al. Journal of Medical Case Reports 2010, 4:409 http://www.jmedicalcasereports.com/content/4/1/409 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Rapidly progressive polyneuropathy due to dry beriberi in a man: a case report Anthony J Howard1, Omesh Kulkarni1, Godwin Lekwuwa2, Hedley CA Emsley1* Abstract Introduction: We describe a case of rapidly progressive and severely debilitating polyneuropathy in a patient with confirmed hypovitaminosis B1, consistent with dry beriberi. Crucially, this is a treatable condition, although sometimes with incomplete recovery, but it is probably under-recognized yet increasingly common given increasing levels of alcohol abuse in the western world. Case presentation: A 49-year-old Caucasian British man presented with progressive weakness of both lower limbs of approximately seven months’ duration. He noted difficulty climbing stairs. He also complained of lethargy, and loss of muscle bulk, including his thighs. He had a history of type 2 diabetes mellitus and admitted prior alcohol abuse but denied excessive alcohol intake in the five years prior to presentation. Initial clinical and neurophysiological examinations were consistent with a mild peripheral neuropathy and probable proximal myopathy. However, over the subsequent four months he evolved a marked tetraparesis, with profound sensory disturbance of all limbs. Repeat neurophysiology revealed a widespread polyneuropathy with extensive acute and sub-acute denervation changes in all four limbs, and reduced or absent sensory nerve action potentials. Hypovitaminosis B1 was confirmed (45 nmol/L, reference range 66-200 nmol/L). His rapid clinical deterioration was in keeping with dry beriberi. He was treated with thiamine. Subsequent follow-up revealed slow but significant improvement, such that by 15-16 months from the initial onset of symptoms, and approximately six months after the onset of his marked tetraparesis, he was able to stand independently and was gradually gaining confidence in walking pending a period of in-patient neurorehabilitation. Conclusion: A potentially wide differential diagnosis exists for this type of presentation. Confirming hypovitaminosis B1 by requesting the assay prior to vitamin replacement ensures accurate diagnosis and appropriate ongoing treatment. An increasingly high index of suspicion is likely to be required in the context of increasing levels of alcohol abuse in the western world and the possible increasing prevalence of dry beriberi. Introduction Dry beriberi or ‘acute nutritional polyneuropathy’ is con- sidered to be rare in the western world. Rapid deteriora- tion can occur, typically with weakness, paraesthesiae and neuropathic pain. Striking motor nerve involvement can occur, mimicking Guillain-Barré syndrome (GBS). Indeed, a GBS-like deterioration has previously been reported [1,2]. In the context of increasing alcohol abuse in the western world, it is possible that alcoholic neuropathy associated with abrupt deterioration due to concomitant * Correspondence: h.emsley@liv.ac.uk 1Department of Neurology, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK Full list of author information is available at the end of the article nutritional hypovitaminosis B1 may be seen increasingly often. Case presentation Initial presentation A 49-year-old Caucasian British man with a long history of type 2 diabetes mellitus (DM) and excessive alcohol intake presented with progressive weakness of both lower limbs of approximately seven months’ duration. He was morbidly obese with a body mass index (BMI) of 45. Over the same period he had noticed thinning of his muscles, particularly noticeable in his thighs. As well as lethargy, he had recently gained weight. Previously he had consumed very high levels of alcohol, but he did not admit to excessive alcohol intake in the five years © 2010 Howard et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.