Abstract
Dengue fever is a viral infection transmitted by mosquitoes with a clinical spectrum that ranges from asymptomatic infection to dengue shock syndrome. Neurologic manifestations are rare. We report a case of dengue fever presented with acute disseminated encephalomyelitis. An 18-year-old boy presented with high-grade fever, generalized headache for three days, intermittent altered sensorium, nausea, and vomiting for one day. Dengue-IgG and Dengue-IgM were positive. Magnetic resonance imaging (MRI) showed abnormal signal intensity areas in the bilateral deep white matter at centrum semiovale more on the right side, which seemed hypointense on T1 and hyperintense on T2 and fluid-attenuated inversion recovery (FLAIR) images, with open ring enhancement on contrast-enhanced T1 image, and peripheral diffusion restriction on diffusion-weighted 1 (DW1) image. These features were suggestive of acute disseminated encephalomyelitis. He improved within a week of taking IV methylprednisolone 1 g once daily for five days and supportive care. Follow up MRI after three weeks showed the resolution of all abnormalities. Thus we conclude that patients with acute disseminated encephalomyelitis should be checked for dengue fever, especially in areas of high prevalence, for early diagnosis and appropriate treatment and to prevent excessively aggressive surgery and/or treatment for such abnormal MRI findings.
Highlights
Dengue fever is a common mosquito-borne viral infection in the tropics
Dengue fever is a viral infection transmitted by mosquitoes with a clinical spectrum that ranges from asymptomatic infection to dengue shock syndrome
We report a case of dengue fever presented with acute disseminated encephalomyelitis
Summary
Dengue fever is a common mosquito-borne viral infection in the tropics. It is caused by a flavivirus. F - Diffusion-weighted 1 (DW1) axial scan showing peripheral diffusion restriction and no diffusion restriction in the center of the lesions He was admitted to the hospital and was given intravenous methylprednisolone 1 g for acute disseminated encephalomyelitis once daily for five days, oral acetaminophen 1000 g for fever and headache twice daily for seven days, intravenous normal saline and oral fluids to keep him hydrated and was advised bed rest. He was discharged from the hospital after one week with advice to take rest, drink plenty of water, and take oral acetaminophen when needed. MRI was repeated at follow up that showed significant improvement of all previous abnormalities
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