Manganese Deposition Encephalopathy Associated With Prolonged Total Parenteral Nutrition: A Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Manganese encephalopathy is a rare neurological disorder most commonly associated with chronic occupational exposure or impaired hepatobiliary elimination. We report a case of suspected manganese deposition encephalopathy associated with prolonged total parenteral nutrition in a critically ill patient with severe abdominal disease and cholestatic dysfunction. A 50-year-old man was admitted with severe abdominal pain, vomiting, tachycardia, and jaundice. Computed tomography demonstrated acute pancreatitis with pancreatic necrosis, choledocholithiasis, cholelithiasis, and superior mesenteric artery thrombosis. His clinical course was complicated by abdominal sepsis, anasarca, anemia, spontaneous hematomas, and the need for prolonged intensive care and total parenteral nutrition. On hospital day 41, he developed rigidity and involuntary movements involving the tongue and upper limbs, prompting neurological assessment. Serum manganese was 3.1 µg/L (reference value: 2 µg/L), and brain magnetic resonance imaging demonstrated T1 hyperintensity in the globus pallidus, findings compatible with manganese encephalopathy. Treatment with levodopa/benserazide produced a limited response, with persistent severe parkinsonism and inability to ambulate despite gradual improvement in tetraparesis associated with concurrent critical illness neuropathy. The patient was discharged on hospital day 129. This case highlights the importance of considering manganese toxicity in critically ill patients receiving prolonged parenteral nutrition, particularly in the setting of impaired biliary elimination, and supports early neurological surveillance and monitoring of trace elements.
Source: Cureus
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W7214905433