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Acute Nutritional Axonal Neuropathy in the Setting of Semaglutide-Associated Gastrointestinal Intolerance: A Case Report

Year: 2026

Type: article

Abstract: Objectives: The aim of the study was to report a unique case of severe sensorimotor polyneuropathy due to acute nutritional axonal neuropathy (ANAN) associated with thiamine and other vitamin deficiencies in the setting of semaglutide-related malnutrition, emphasizing early recognition and intervention to prevent permanent neurologic injury. Methods: A 65-year-old woman with type 2 diabetes and obesity presented with profound weakness, cranial nerve deficits, dysphagia, and a 120-pound weight loss after months of semaglutide therapy with persistent nausea and vomiting. Neurologic examination was performed, and cerebrospinal fluid analysis and serum vitamin levels were obtained. Electromyography demonstrated absent sensory responses and mild motor slowing, consistent with severe sensory-predominant polyneuropathy. Serum levels of thiamine, folate, and vitamin B12 were below normal, and supplementation was administered. Results: Within 5 days of thiamine, folate, and vitamin B12 supplementation, the patient showed improvement in cognition and bulbar and limb strength. Oral intake improved over 1 week, and partial functional recovery was achieved. Discussion: This case of ANAN highlights a severe yet potentially reversible neurologic complication of nutritional deficiencies occurring in the setting of GLP-1 receptor agonist-associated gastrointestinal intolerance and malnutrition. Recognizing and addressing nutrient deficiencies in patients with sensorimotor and/or cognitive deficits after persistent gastrointestinal symptoms can improve deficits and prevent long-term or permanent neurologic injury. Practical Implications: Clinicians should maintain a high suspicion for thiamine, folate, vitamin B12, and other nutritional deficiencies in patients on GLP-1 receptor agonists presenting with neuropathy, unexplained weakness, cranial nerve deficits, and/or confusion, as prompt supplementation may mitigate neurologic injury.

Source: Case Reports in Neurology

DOI: 10.1159/000552961

Authors: Chloe J. Cohan, Liam Townley, Erik Ortega

Institutions: Creighton University, Barrow Neurological Institute

Language: English

Topic: Alcoholism and Thiamine Deficiency

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,030