Case report: Mononeuritis multiplex in the course of dengue fever
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CASE REPORT
Open Access
Case report: Mononeuritis multiplex in the course of dengue fever Jun Yang Ho, Yee Kent Liew, Jiashen Loh* and Pothiawala Sohil
Abstract Background: Dengue fever usually presents as a self-limiting acute febrile illness with worsening thrombocytopenia, with a small minority of patients developing hemorrhagic or life-threatening complications. Organ specific manifestations like myocarditis, acalculous cholecystitis, encephalitis has been described but are uncommon presentations. Even more rarely, such manifestations are the presenting complaint of Dengue fever. In this case report, we highlight a case of Dengue fever where unrelated neuropathies were the presenting complaint. Case presentation: An elderly man presents with 1 day of diplopia and left foot drop, associated with 2 days history of fever. A decreasing white cell count (WBC) and platelet on the 2nd day of admission prompted Dengue virus to be tested and a positive NS-1 antigen was detected, confirming the diagnosis of Dengue fever. He was treated with supportive treatment with a short duration of intravenous fluids recovered uneventfully and was discharged 6 days after admission with almost full resolution of diplopia and partial resolution of left foot drop. Left foot drop recovered completely 2 weeks later. Conclusion: Neurological manifestations can be the presenting symptoms in Dengue fever, a diagnosis which should be borne in mind when such symptoms present in patients from endemic areas or in returning travellers from these areas. Keywords: Diplopia, Mononeuritis multiplex, Dengue, Abducens nerve, Foot drop
Background Dengue fever is a vector-borne infection caused by the dengue viruses of the Flaviviridae family, which consists of four serotypes (DenV-1, DenV-2, DenV-3 and DenV4). It is estimated that there are around 390 million dengue infections per year [1] spanning across 128 countries [2]. The major burden of this disease, nearly 75%, is borne by the South-East Asian region and the Western Pacific region. The estimated fatality rate is about 1% in the South-East Asia region [3]. While dengue fever commonly presents with febrile illness and no localizing source of infection, it can manifest with neurological symptoms. Dengue guidelines released by WHO in 2019 incorporated central nervous * Correspondence: [email protected] Seng Kang General Hospital, Singapore, Singapore
involvement in the definition of severe disease [3]. However, no neurological features have been specifically associated with dengue fever. There have been reported cases of patients who present with neurological symptoms and dengue virus was isolated from their cerebrospinal fluid, suggesting that the virus crosses the bloodbrain barrier and directly invades the brain causing encephalitis [4] [5]. With increasing evidence of dengue neurotropism, an effort was made to categorize dengue related neurological features into 4 groups, namely, dengue encephalopathy, encephalitis, neuromuscular complication and neuro-ophthalmic involvement [6]
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