Optic Neuritis and Acute Transverse Myelitis after Chikungunya virus infection

Abstract

Background: Since 2015, an outbreak of the Chikungunya virus (CHIKV), was identified in north and northeastern Brazil and Caribbean. The infection has demonstrated itself to be benign and self-limited in the vast majority of cases; however, complications, including injuries to the central and peripheral nervous systems, have been reported. Complete Acute Transverse Myelitis (ATM) associated with Optic Neuritis (ON) after this virus infection has never been reported in the literature. Methods & Materials: Medical record and clinical interview. Results: Case report: 63-year-old white woman, presented after acute fever, headache, and arthralgia, urinary retention associated with progressive paraparesis, evolving with paraplegia in a few days. Simultaneously presented reduction of visual acuity, sudden installation, associated with bilateral diplopia. The beginning of neurological symptoms surfaced about of 30 days after the beginning of fever. Confirmed the serological diagnosis of CHIKV (IgM/ELISA). Spinal cord MRI showed multiple lesions in cervical and thoracic areas, with gadolinium uptake. Assessment of visual acuity was reduced in both eyes, with bilateral scotomas. Cerebrospinal fluid analysis revealed normal patterns of protein and glucose, but lymphocytic pleocytosis. Bacterial (Gram and Ziehl Neelsen methods), fungal (Cryptococcus) and viral (herpes simplex, cytomegalovirus, varicella-zoster, HTLV, dengue, zika and chikungunya) analyses were negative; intrathecal synthesis of IgG, IgM and oligoclonal bands presented with normal values. Blood test results were normal throughout the clinical course. She began treatment with methylprednisolone (1 g/daily) for 3 days. There was visual deficit improvement and total disappearance of spinal cord lesions, but with persistence of motor neurological deficits. Conclusion: This is an unprecedented case report of association between the CHIKV infection and neurologic manifestations: optic neuritis and acute transverse myelitis. Although the association between the arbovirus and demyelinating syndromes is rare it is possible the involvement of the nervous system secondary to the infectious process. If a patient who lives in or who has traveled to an area with endemic CHIKV presents with signs of ATM or ON, the existence of this agent must be investigated. If its presence is confirmed in the blood and/or CSF, in the absence of other causes, its relationship with nervous injury is confirmed.