Believe Your Patient Who Denies Alcohol Dependence/Celiac Disease as a Cause of Wernicke Encephalopathy

We describe a patient admitted with altered mental status and nutritional deficiency who was misdiagnosed with Wernicke Encephalopathy. Subsequently, as an outpatient, she was diagnosed with Celiac disease (CeD) following extensive neurologic workup. While CeD and other gluten-associated disorders are typically associated with gastrointestinal symptoms, patients may also present with neurologic symptoms, such as altered mental status, ataxia, and encephalopathy. Once a gluten-free diet was initiated along with nutritional supplements, the patient's mental status gradually improved. Given CeD's diverse symptom profile, it can often be a challenging to clinically suspect and diagnose accurately.