RESUMO
Wet beriberi, characterized by high cardiac output with predominantly right-sided heart failure and lactic acidosis, is a disease caused by thiamine deficiency, and is rarely seen in modern society. However, patients with social withdrawal syndrome, also known as hikikomori syndrome, may be a new population at risk of thiamine deficiency. Hikikomori syndrome, first recognized in Japan, is becoming a worldwide issue. A 39-year-old Japanese patient was brought to our hospital, with a 3-week history of progressive shortness of breath and generalized edema. The patient had right-sided high-output heart failure, lactic acidosis, and Wernicke-Korsakoff syndrome. Because of his history of social isolation, we diagnosed hikikomori syndrome according to the Japanese government's definition, which is as follows: lifestyle centered at home; no interest or willingness to attend school or work; persistence of symptoms beyond 6 months; and exclusion of other psychiatric and developmental disorders. Considering his diagnosis of hikikomori syndrome and social isolation, we suspected malnutrition, particularly thiamine deficiency, and successfully treated him. Clinicians should be aware of the potential risk of thiamine deficiency associated with hikikomori syndrome and initiate thiamine replacement in cases of high-output heart failure associated with lactic acidosis.
Assuntos
Beriberi/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Síndrome de Korsakoff/diagnóstico por imagem , Isolamento Social , Deficiência de Tiamina/diagnóstico por imagem , Adulto , Beriberi/tratamento farmacológico , Beriberi/psicologia , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/psicologia , Humanos , Relações Interpessoais , Síndrome de Korsakoff/tratamento farmacológico , Síndrome de Korsakoff/psicologia , Masculino , Isolamento Social/psicologia , Síndrome , Deficiência de Tiamina/tratamento farmacológico , Deficiência de Tiamina/psicologia , Complexo Vitamínico B/administração & dosagemAssuntos
Beriberi , Dieta , Emigrantes e Imigrantes , Distúrbios Nutricionais , Relações Raciais , Condições Sociais , Beriberi/etnologia , Beriberi/história , Beriberi/psicologia , Produtos Agrícolas/economia , Produtos Agrícolas/história , Dieta/economia , Dieta/etnologia , Dieta/história , Dieta/psicologia , Surtos de Doenças/economia , Surtos de Doenças/história , Emigrantes e Imigrantes/educação , Emigrantes e Imigrantes/história , Emigrantes e Imigrantes/legislação & jurisprudência , Emigrantes e Imigrantes/psicologia , Emigração e Imigração/história , Emigração e Imigração/legislação & jurisprudência , Emprego/economia , Emprego/história , Fiji/etnologia , História da Medicina , História do Século XIX , Japão/etnologia , Necessidades Nutricionais/etnologia , Ciências da Nutrição/educação , Ciências da Nutrição/história , Preconceito , Queensland/etnologia , Relações Raciais/história , Relações Raciais/legislação & jurisprudência , Relações Raciais/psicologia , Classe Social , Condições Sociais/economia , Condições Sociais/história , Predomínio SocialRESUMO
The Wernicke-Korsakoff syndrome (WKS) is the most frequently encountered manifestation of thiamine deficiency in Western society. It is commonly seen in alcoholic patients, but may also occur in patients with impaired nutrition from other causes, such as those with gastrointestinal disease or AIDS. The pathology is restricted to the central nervous system and is characterised by neuronal loss, gliosis and vascular damage in regions surrounding the third and fourth ventricles and the cerebral aqueduct. In addition to WKS, thiamine deficiency may also result in beriberi, a cardiac and peripheral nervous system disease, and it has been implicated in the pathogenesis of cerebellar degeneration and peripheral neuropathy. Thus thiamine deficiency results in significant nervous system pathology and vigilance should be maintained in the diagnosis and treatment of this readily preventable cause of disease.