Introduction Thiamine deficiency (TD), arising from inadequate intake or increased metabolic demand, is an underrecognized complication in oncology. While commonly associated with Wernicke encephalopathy (WE), its subclinical form often precedes overt neurological symptoms. Gastric cancer (GC) patients are at high risk due to malnutrition and cachexia. This case highlights the critical importance of proactive TD screening in malnourished cancer patients to prevent irreversible neurological sequelae. Case Presentation A 58-year-old non-alcoholic female with a smoking history presented with hematemesis. Endoscopy and biopsy confirmed gastric adenocarcinoma (signet-ring cell type). She initially declined treatment. One month later, she returned with rapid clinical deterioration: 17 kg weight loss and profound anorexia, but no neurological deficits. Informed by a family history of malignancy with neuropsychiatric symptoms, serum thiamine was tested and revealed severe deficiency (21 ng/mL; normal 30–70). Intravenous thiamine replacement was initiated. Conclusion This case underscores that overt neurological signs are not a prerequisite for significant TD in high-risk oncology patients. A low threshold for screening—based on nutritional status and rapid weight loss—is essential, particularly in resource-limited settings where advanced diagnostic tools are scarce. Proactive thiamine replacement can prevent the development of full-blown WE, potentially improving a patient's candidacy for and tolerance of anticancer therapies. Integrating nutritional deficiency screening into standard oncological workup is a simple, cost-effective measure to reduce morbidity.
Al-Bitar et al. (Sat,) studied this question.