Unusual Neurological Manifestation of Dengue Fever

Abstract

Background: Neurological manifestations are considered to be a rare part of dengue fever. The frequency of neurological involvement is not exactly known. Only few cases have been reported in literature from South Asia and Africa. Dengue fever is an arboviral infection with systemic involvement. Neurological complications can occur in the form of encephalitis, seizures, encephalopathy, aseptic meningitis, intracranial haemorrhage, polyneuropathies and Guillain barre syndrome, transverse myelitis etc. These features can be associated with other comorbidities and complications like prolonged shock. Case Presentation: We are present a case of 50 years female resident of Punjab India, who presented to us with fever of 4 days duration, myalgias, altered mental status, followed by sudden onset paraparesis with urinary incontinence. On examination, there was flaccid paraparesis, areflexia with patchy area of sensory loss without any definite level, neck rigidity and no other significant finding. Routine investigations showed thrombocytopenia, with normal liver and renal functions, tropical fever serology was positive for dengue IgM. After recovery of thrombocytopenia, cerebrospinal fluid examination was done which showed 40 cells predominantly lymphocytes, high protein and normal sugars, fluid was also positive for dengue IgM and dengue PCR. Nerve conduction studies showed acute sensory motor axonal neuropathy. Thus, finally a diagnosis of dengue encephalitis with Guillain barre syndrome was made and patient was started on Immunoglobulin therapy. Patient did respond to the treatment and has now recovered completely over 3 months.  Conclusion: Neurological complications which occurs after dengue infection due to physiological response of body to dengue virus, can affect body in different forms and systems. Usually the central nervous system involvement and peripheral nervous system involvement and local complication due to  direct viral effect like myositis and  periodic paralysis occur at different time, but rarely both CNS (encephalitis) and PNS (GBS) complication can occur in same patient at the same time.