Wernicke encephalopathy in a patient with severe acute pancreatitis

36-years-old male patient with history of biliary severe acute pancreatitis (SAP) before 4 months. Endo- scopic retrograde cholangiopancreatography (ERCP) was done for the patient at that time and common bile duct stones removed and the patient was discharged. He came before 1 month complaining of fever, abdominal pain and swelling. Physical examination revealed abdominal tenderness and ascites. Chest auscultation showed bilateral decreased air entry. Glucose: 177 mg/dL, AST : 64 U/L, ALT : 114 U/L, LDH : 986 U/L, total/conjugated bilirubin : 2.8 mg/dL/ 1.6 mg/dL, amylase : 1552 U/L, lipase : 1238 U/L, CRP : 36.2 mg/dl, WBC : 21,550 mm3, hematocrit : 36% and platelets : 366,000 mm3. Computed Tomography showed acute pancreatitis with areas of necrosis at the level of the head and tail of pancreas. There was a 18 × 5 cm cystic degeneration in the body of the pancreas with air bubbles observed inside it (Fig. 1).