Dengue breathing down our neck: A case report of dengue encephalitis

Abstract

Introduction: There has been a resurgence of dengue worldwide in the tropics and it has emerged as one of the most common mosquito-borne infections brought back by travelers to the temperate regions. Although considered an unusual presentation, dengue encephalitis has to be considered in a returning traveler presenting with fever accompanied by neurological symptoms. Case Report: A 50-yearold Singaporean female with poorly controlled diabetes presented with a neck abscess. She had persistent fever despite adequate drainage of the abscess. Her repeat blood count four days after the admission revealed that she had developed thrombocytopenia (platelets 13x109/L). She was found to have dengue fever based on a positive serum dengue NS1 antigen. Subsequently, she presented with neurological symptoms. Dengue encephalitis was confirmed by a positive dengue PCR (DEN-4 serotype) on lumbar puncture. Conclusion: With the increasing incidence of dengue and the expansion of air travel worldwide, one would expect to see an uncommon manifestation such as dengue encephalitis even in non-endemic areas. Dengue encephalitis should be considered in returning travelers from the tropics as well as patients in the endemic areas who present with viral fever and neurological symptoms.