DOI: 10.36347/sjmcr.2017.v05i10.011

Pages: 639-641

A 42-year-old male admitted to a local psychiatric facility fell unconscious, and his oxygen saturation decreased to 40% on the first hospital day. The medical staff could not respond to this situation and called an ambulance. A doctor car was dispatched and docked with the ambulance. As the patient remained in a deep coma state, he underwent tracheal intubation at the rendezvous point. He had a history of drinking 360 g of ethanol per day. On arrival, he received infusion of vitamin B1. On a physical examination, both eye balls were in the abductor position. A urinary qualitative test for drugs was negative. The level of vitamin B1 was 24.0 (normal range: 21.3-81.9) ng/ml. Whole-body computed tomography (CT) revealed low density at the splenial area, left dorsal consolidation at the left lung and fatty liver changes. Magnetic resonance imaging immediately after CT revealed an isolated splenial lesion. He received a diagnosis of Marchiafava-Bignami disease (MBD), alcoholic hepatitis, alcoholic rhabdomyolysis and aspiration pneumonia. After admission to the intensive-care unit, he underwent infusion of thiamine and antibiotics. On the third hospital day, his respiratory function and consciousness recovered, an extubation was performed. At that time, he had disorientation and dysarthria. After regaining his ability to feed himself, he was transferred to the previous psychiatric facility. He ingested vitamin B1 until transportation. We herein report a rare case of MBD diagnosed based on MRI findings and the patient’s history of alcohol consumption. Immediate and continuous infusion of thiamine is important for MBD even the level of vitamin B1 is the normal range.