Marchiafava-Bignami disease is a rare affliction characterized by primary
degeneration of the corpus callosum associated with chronic consumption of ethanol.
The disease may occasionally occur in patients who are not alcoholics but are
chronically malnourished. A complex deficiency of group B vitamins is the main
etiopathogenic hypothesis, and many patients improve after the administration of
these compounds. However, a good response is not always observed. The definitive
diagnosis of Marchiafava-Bignami disease can be problematic and is based on features
of neuroimaging studies, especially magnetic resonance imaging. Its treatment is
still controversial and shows variable results. Because nutritional factors are
implicated, as in Wernicke's encephalopathy, some authors claim that replacement of B
vitamins is beneficial. The present article is a case report of a severe acute form
of Marchiafava-Bignami disease in an alcohol-dependent male patient who improved
after the administration of parenteral B vitamins. As a consequence of his
neurological and immunologic conditions, he developed multiple pulmonary infections
and had a protracted course in the intensive care unit. He eventually died of sepsis
associated with an uncommon fungus, Rhodotorula mucilaginosa. The
present article reports the clinical and neuroimaging data from this patient and
contains a review of Marchiafava-Bignami disease and Rhodotorula
infections in the intensive care unit.