Was it a case of acute disseminated encephalomyelitis? A rare association following dengue fever
A 32-year-old female from rural background presented in medical outpatient department with complaints of high grade fever with chills, myalgias and arthralgia along with abdominal pain and occasional vomiting for 5-6 days. She was febrile and had tachycardia. Rest of the examination was normal. Her investigations showed thrombocytopenia (platelet count 60,000/cmm) and positive serology for acute dengue infection. The serum IgM antibody to dengue virus was positive. The serum IgM antibody were analyzed by ELISA method using IgM ELISA Kit by Panbio Invernis Medical Innovations, Australia. We could not assess type of dengue infection due to technical constraints. She was treated conservatively and shown improvement. About two weeks later she returned in emergency ward in state of altered consciousness with history of two episodes of generalized tonic clonic convulsions. She had normal vitals and general examination except mild pallor. Neurological examination revealed that she was drowsy but arousable and disoriented. There was no apparent cranial nerve palsy, motor deficit or signs of meningeal irritation. Ophthalmological evaluation did not show any abnormality. Her hematological and biochemical parameters were also within normal limits.\nCerebrospinal fluid examination (CSF) revealed total leukocyte count 320/cmm with 85% lymphocytosis, CSF proteins 200 mg/dl. CSF glucose, chloride and adenosine deaminase were within normal limits. Gram stain and microscopy for Mycobacterium tuberculosis was negative. Magnetic resonance imaging (MRI) brain revealed patchy areas of hyper intense signals on FlAIR (fluid attenuated inversion recovery sequence) images [Figure –]. ELISA for HIV was negative. Serology for viral hepatic markers, Japanese encephalitis, Epstein Barre virus and HSV-1 was also negative. She was treated with intravenous methyl prednisolone 1 gm once daily for five days then oral prednisolone 40 mg/day tapered over 3-4 weeks. Rapid clinical improvement was noticed. The repeat MRI after two weeks also showed almost complete resolution of patchy demyelinating lesions [].