A Rare But Typical Presentation of Post-Bariatric Polyneuropathy and Acute Rehabilitation Outcome

ABSTRACT

Case Diagnosis A 21-year-old female with a past medical history of gastric sleeve surgery admitted to acute inpatient rehab with bilateral lower extremity weakness and neuropathic pain who recovered after intramuscular vitamin supplementation. Case Description A 21-year-old female with a past medical history of gastric sleeve surgery presented with bilateral lower extremity weakness with pins and needles sensation to her feet and a mild sore throat. During her initial hospital visit, patient was diagnosed with mild COVID-19 and as there was concern for Guillain-Barre syndrome (GBS), lumbar puncture was performed and GBS was ruled out. However, patient underwent IVIG treatment for empiric symptom management without improvement. Patient was subsequently admitted to acute inpatient rehabilitation. Setting(s) Acute Inpatient Rehab. Assessment/Results: Upon examination, patient presented impaired bilateral lower extremity weakness, absent lower extremity reflexes and paresthesias. Patient was unable to stand or ambulate due to lower extremity weakness and pain. Lumbar puncture performed and GBS ruled out due to lack of albuminocytological dissociation. Patient underwent course of two courses of IVIG, with no improvement of symptoms. Vitamin deficiency workup revealed insufficient vitamin B1 levels. Over the course of two weeks, she was started on daily vitamin B1 which led to a rapid improvement of her polyneuropathy and weakness. Upon discharge, patient was ambulating 150 feet with the use of a rolling walker and had complete resolution of her bilateral lower extremity neuropathy. Discussion(s) Bariatric surgeries are used to treat the ever-growing problem of obesity in America. Although bariatric surgery improves the overall quality of life in patients, acute and chronic neurologic complications such as polyneuropathies do occur and can be debilitating. It is important to complete vitamin workup in patients with history of bariatric surgery. Conclusion(s) Early diagnosis and treatment of vitamin deficiency after bariatric surgery can help prevent worsening polyneuropathies and bring back quality of life.