Thiamine-responsive, life-threatening, pulmonary hypertensive crisis with encephalopathy in young infants: A case series

Objective: Thiamine (Vitamin BI) deficiency (TD), although reduced in incidence, is still seen in infants. We describe a rarely reported form of infantile TD with life-threatening pulmonary hypertensive crisis and severe encephalopathy, with dramatic response to thiamine supplementation. Methods: Study design: Descriptive case series. Six young infants with mean age 76 days (range 1-3 months), manifesting rapidly progressive encephalopathy and cardio-pulmonary arrest were included. All infants underwent cardiac, neuroimaging and metabolic evaluations. Results: All six infants had similar presentation with severe pulmonary arterial hypertension (PAH), hypotensive shock, metabolic acidosis and severe encephalopathy. All infants were exclusively breast-fed. Thiamine treatmwnt resulted in dramatic improvement in haemodynamic and neurological function in all the infants. There were no major neurological deficits on follow up. Conclusion: A high index of suspicion is warranted for this rarely described form of TD, as early identification helps in preventing mortality and morbidity. (C) 2021 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.