To present a case of severe thiamine deficiency mimicking GBS in the absence of Wernicke’s encephalopathy in a young female with alcohol use and significant weight loss.

Thiamine deficiency can result from chronic alcohol use, anorexia, or malabsorption and can present with Wernicke’s encephalopathy, dry beriberi, or wet beriberi. Dry beriberi can mimic GBS given similar clinical findings of ascending weakness, sensory changes, and areflexia in the lower extremities. Dry beriberi is often the presenting symptom of thiamine deficiency but usually occurs with Wernicke’s encephalopathy in alcoholics.

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A 30-year-old female presented with one week of worsening ascending weakness, numbness, and pain in her lower extremities. She had lost 75 pounds in the past four months attributed to poor oral intake. On exam, she had no cognitive deficits and demonstrated severe weakness, areflexia, and decreased sensation to pain, vibration, and light touch in her lower extremities. Magnetic resonance imaging of the neuraxis was unremarkable. Cerebrospinal fluid basic studies were normal with no albuminocytologic dissociation seen. She was started on intravenous immunoglobulin for concern of GBS. Phosphatidyl ethanol 16:0/18:1 was 704 ng/mL. Thiamine was less than 2 nmol/L. Electromyography showed evidence of a sensorimotor radiculoneuropathy with no demyelinating findings aside from the left peroneal nerve. She was diagnosed with an acute axonal neuropathy secondary to thiamine deficiency. Thiamine supplementation was started and no signs of Wernicke’s encephalopathy were noted during her admission.

Severe thiamine deficiency can present with an acute axonal neuropathy mimicking GBS even in the absence of Wernicke’s encephalopathy. Thiamine deficiency should be considered in all patients presenting with neuropathy who have a history of alcohol use, anorexia, or significant weight loss. It is important to consider and recognize thiamine deficiency since early treatment may prevent the development of Wernicke’s encephalopathy and further neurologic complications.