Three days later he presented unusual behavior and disorientation. A cranial computed tomography scan was obtained and acute vascular lesions were excluded. Wernicke encephalopathy (WE) was suspected based in clinical evidence, RO4929097 molecular weight despite multivitamin supplementation in parenteral nutrition. Laboratory tests to assess thiamine levels and Magnetic Resonance Imaging (MRI) were not promptly available. Empiric treatment with high doses of intravenous thiamine (200 mg 3 times daily) was administrated due to the low incidence of adverse effects of the treatment. In the first 24 h of treatment, a significant improvement

was observed. The patient no longer presented signs of encephalopathy. Eye movements normalized during the following week. Oral feeding was restarted, successfully, without dysphagia or vomiting. The patient was later discharged, on daily oral multivitamin supplementation and intramuscular

thiamine 100 mg/day, which he maintained for several months. In March 2011, anti‐TNFα therapy was reinitiated, with clinical remission of CD and mild neurologic complaints, with a relapsing‐remitting pattern. The case report aims at highlighting acute neurologic manifestations in a patient with severe CD. Malnutrition and weight loss are frequently observed in patients with IBD, especially CD. This condition can result from multiple factors, including reduced food intake, malabsorption, diarrhea and oxidative stress, all of which can be worsened by disease

activity.5 Filippi et al, evaluated 54 consecutive CD patients in clinical remission, Navitoclax purchase assessing body composition, resting energy expenditure, nutrient intake, and plasma concentration. These patients were compared to 25 healthy controls. According to their results macronutrient needs are usually covered Dimethyl sulfoxide by food intake when patients are in remission; however, micronutrient deficiencies are frequent and call for specific screening and treatment.6 Our patient was malnourished for a long period of time, probably even before CD diagnosis, which may explain his low stature and weight. When the disease was active his nutritional status worsened despite oral nutritional supplements administration. In November 2010, when he was admitted with severe esophageal candidiasis, his nutritional condition was poor and adjusted nutritional support was provided. The infectious intercurrences related to his immunosuppressed condition were life‐threatening but were successfully treated. When he presented with ophthalmoplegia and cognitive impairment, clinical diagnosis of WE was suspected, although standard parenteral multivitamin supplementation was being provided. The clinical improvement after thiamine infusion confirmed the diagnosis. The resolution of dysphagia and gastroparesis with thiamine administration suggests that these symptoms were also related to thiamine deficiency, and in this particular case, were early symptoms.