Manganese Deposition Encephalopathy Associated With Prolonged Total Parenteral Nutrition: A Case Report
- 1General Surgery, Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina (UFSC), Florianópolis, BRA
- 2Critical Care Medicine, Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina (UFSC), Florianópolis, BRA
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.
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BibTeX
@article{faggion2026manganese,
title = {{Manganese Deposition Encephalopathy Associated With Prolonged Total Parenteral Nutrition: A Case Report}},
author = {Bruno Zanardo Faggion and Laura A Vicenzi Souza and Giancarlo Beluzzo da Mota de Lima Sinke and Rafaela Collaço de Oliveira Valente},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117250},
url = {https://europepmc.org/article/PMC/PMC13722496},
note = {CC BY},
}
RIS
TY - JOUR
TI - Manganese Deposition Encephalopathy Associated With Prolonged Total Parenteral Nutrition: A Case Report
AU - Bruno Zanardo Faggion
AU - Laura A Vicenzi Souza
AU - Giancarlo Beluzzo da Mota de Lima Sinke
AU - Rafaela Collaço de Oliveira Valente
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117250
UR - https://europepmc.org/article/PMC/PMC13722496
AB - 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.
SN - 2168-8184
ER -