“Dry” and “wet” beriberi mimicking critical illness polyneuropathy
A 44-year-old non-alcoholic male was admitted with dyspnea, vomiting, upper abdominal pain, oliguria, and weakness of both the lower limbs of 3 days duration. He was admitted thrice in the previous 1 month for symptoms of heart failure at a peripheral hospital, with partial recovery each time upon conservative treatment. On admission, patient had tachypnea, unrecordable blood pressure, heart rate 136/min, elevated Jugular Venous Pressure (JVP), and bilateral pitting edema of legs. Systemic examination revealed right sided S3, systolic murmur of 3/6 intensity at the lower left sternal edge and 3 cm tender hepatomegaly. Bilateral lower limb power was 3/5 with sluggish deep tendon reflexes.\nElectrocardiography (ECG) revealed sinus tachycardia with ST depression in leads V3-V6. Arterial Blood Gas analysis showed severe metabolic acidosis []. 2D echocardiography on admission showed dilated Right atrium/Right ventricle (RA/RV) with mild tricuspid regurgitation and pulmonary hypertension []. A provisional diagnosis of right heart failure with the multiorgan dysfunction possibly due to sepsis or cardiac beriberi was made and he was managed conservatively with broad spectrum antibiotics, sodium bicarbonate infusion, inotropes, and thiamine infusion. Acidosis, shock, and renal failure recovered promptly over from 24 h to 48 h. However, his paraparesis worsened over the next 2-3 days and Nerve conduction study (NCS) suggested predominantly motor, axonal type of peripheral neuropathy []. With continued thiamine supplementation, his power in the lower limbs gradually improved and he was discharged in 2 weeks with near normal power in the lower limbs.