Between December 2015 and March 2016, hospitals in the Klang Valley, Malaysia received a number of patients with similar extreme presentation followed by dramatic recovery. Ten cases from three institutions were studied and their diseases progress was analyzed. It revealed an almost forgotten disease, which requires high index of suspicion to diagnose yet, cheap but highly effective medicine to treat.
Ten Burmese males whose age ranging from 22 to 41 years old presented with worsening shortness of breath associated with abdominal pain and vomiting. Eight patients had been under detention for seven to ten months for being illegal immigrants. Eighty percent of patients were in shock and respiratory distress with severe metabolic acidosis, requiring intubation and haemodynamic support. Majority of them also had acute kidney and liver injuries. Point of care echocardiography revealed severe dilatation of the right heart with pericardial effusion. Diagnosis of Shoshin Beriberi was subsequently made and all patients were treated with high dose of intravenous thiamine. Dramatic recoveries were observed in 90.0 percent of patients with reversal of the heart, kidneys and liver injuries.
Shoshin Beriberi is a forgotten disease in some part of the world. It is due to thiamine deficiency that affects cells metabolism leading into low output cardiac failure. The diagnosis relies on high index of suspicion based on the history and clinical presentation as well as the dramatic improvement after thiamine administration. Difficult access to thiamine-enriched meals for more than three months increases the risk of the disease. Burmese male has the risk of developing the disease possibly due to their habits and lifestyle.
Thiamine has an important role in cardiac dysfunction of unknown origin. Awareness must be instilled among detention centres and prisons as prevention of Shoshin Beriberi is better and cheaper than the cure.