Wernicke’s Encephalopathy Post-cmv Infection in a Liver Transplant Patient: A Case Report

Introduction: Wernicke’s Encephalopathy (WE) is an acute neurological disorder resulting from vitamin B1 deficiency. Liver transplant (LT) and associated secondary infections may pose a risk factor for such patients due to the increased metabolic demands of surgery and the postoperative period. However, limited literature is available on such cases

Methods: We present the case of a 63-year-old male, a known case of hypothyroidism, primary hypertension, hypocortisolism, and post-op steroid-induced DM, who presented with complaints of severe bradyphrenia and bradykinesia 2 months after undergoing a liver transplant for decompensated liver failure. The patient had an active cytomegalovirus (CMV) infection at the time of presenting which developed 1-month post-op for which he was currently being treated.

Results: On examination, the patient was found to have ophthalmoplegia and truncal rigidity with gait ataxia raising suspicion of Wernicke’s Encephalopathy (WE). A brain MRI was conducted and found to have near symmetrical FLAIR hyper-intensive signals along the periaqueductal region in the midbrain, bilateral mammillary bodies, and medial thalami with global cerebral atrophy disproportionate to the patient's age, further strengthening the diagnosis for Wernicke's encephalopathy. The patient was started on thiamine injections 8 hourly, benfotiamine, and levodopa. The patient gradually improved symptomatically and was hence discharged and followed up.

Conclusion : Liver transplantation may increase metabolic demand and put the patient at risk of secondary infections during the surgical and postoperative periods, making it a risk factor for Wernicke's encephalopathy. The majority of cases in liver transplant patients may be misdiagnosed or overlooked, hence they should be actively looked for and promptly treated if detected to prevent long-term complications in such patients. More research is required in this population to develop appropriate preventive and screening regimens for these patients to avoid the development of Wernicke's encephalopathy.