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Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab

Published online by Cambridge University Press:  03 August 2018

Hideki Onishi ,
Mayumi Ishida ,
Hiroshi Kagamu ,
Yoshitake Murayama ,
Kunihiko Kobayashi ,
Izumi Sato ,
Nozomu Uchida  and
Tatsuo Akechi
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Hiroshi Kagamu
Affiliation:
Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Yoshitake Murayama
Affiliation:
Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Kunihiko Kobayashi
Affiliation:
Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Izumi Sato
Affiliation:
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan E-mail: honishi@saitama-med.ac.jp
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Abstract

Objective

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. It is recognized in various stages of the cancer trajectory but has not previously been recognized during nivolumab treatment.

Method

From a series of WE patients with cancer, we report a lung cancer patient who developed WE during treatment with nivolumab.

Result

A 78-year-old woman with lung cancer was referred to our psycho-oncology clinic because of depressed mood. Psychiatric examination revealed disorientation to time, date, and place, which had not been recognized 1 month previously. Her symptoms fulfilled the diagnostic criteria for delirium. No laboratory findings or drugs explaining her delirium were identified. WE was suspected as she experienced a loss of appetite lasting 4 weeks. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after intravenous thiamine administration.

Significance of results

We found WE in an advanced lung cancer patient receiving treatment with nivolumab. Further study revealed the association between nivolumab and thiamine deficiency. Oncologists should consider thiamine deficiency when a patient experiences a loss of appetite of more than 2 weeks regardless of the presence or absence of delirium.

Keywords

ThiamineNivolumabWernicke encephalopathyDeliriumCancer
Type
Case Report
Information
Palliative & Supportive Care , Volume 17 , Issue 2 , April 2019 , pp. 245 - 247
Copyright
Copyright © Cambridge University Press 2018 

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