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Niraula B, Adhikari B, Suvedi A, Gosain D, Gaud SK. Unilateral lateral rectus palsy following dengue: a case report. Ann Med Surg (Lond) 2024; 86:3154-3158. [PMID: 38694359 PMCID: PMC11060301 DOI: 10.1097/ms9.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/11/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance Dengue fever is a mosquito-borne viral infection presenting with high-grade fever and other constitutional symptoms. Case presentation This case report details a rare occurrence of lateral rectus palsy in an 18-year-old male subsequent to dengue infection. The patient initially presented with fever, a generalized tonic-clonic seizure (GTCS), and symptomatic hypoglycemia, leading to multiple organ dysfunction syndrome (MODS) necessitating intensive care. Remarkably, no haemorrhagic manifestations were observed. The MODS gradually resolved by the 12th day of admission, coinciding with the emergence of complaints about uniocular diplopia and right esotropia. Systemic examination, including a normal computed tomography (CT) head scan, did not reveal any abnormalities. Additionally, potential causes contributing to esotropia and diplopia were ruled out. The patient was subsequently managed expectantly for lateral rectus palsy following severe dengue. Follow-up assessments indicated a gradual improvement in esotropia and diplopia, and the patient was advised to continue the prescribed medications. Conclusion This is the first documented case report of paralytic squint post-severe dengue in Nepal, emphasizing the importance of considering it as a differential diagnosis in tropical regions with endemic dengue infections. The case report advocates early identification and treatment of ophthalmic issues, notably with prednisolone, to achieve favourable outcomes, as evidenced by improvements in visual acuity, esotropia, and diplopia during follow-ups. Further research is essential to determine optimal treatment strategies for such neurological complications associated with dengue fever.
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Affiliation(s)
| | - Bindira Adhikari
- Chitwan Medical College Teaching Hospital, Bharatpur -10- Chitwan, Nepal
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Mishra A, Tripathi A, Bhirud A, Agrawal M, Gupta S, Parihar JKS. Ophthalmic manifestations as the first presenting feature in dengue fever: a 10-year study. Rom J Ophthalmol 2024; 68:31-36. [PMID: 38617719 PMCID: PMC11007566 DOI: 10.22336/rjo.2024.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.
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Affiliation(s)
- Avinash Mishra
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Anchal Tripathi
- Department of Ophthalmology, Military Hospital, Jammu, India
| | - Atul Bhirud
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Mohini Agrawal
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Sandeep Gupta
- Department of Ophthalmology, Command Hospital, Chandimandir, Punjab, India
| | - JKS Parihar
- Department of Ophthalmology, Centre for Sight, New Delhi, India
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Loh SA, Wan Abdul Rahman WMH, Sonny Teo KS, Abu N. A Unique Case of Unilateral Oculomotor Nerve Palsy Secondary to Dengue Fever. Cureus 2023; 15:e35281. [PMID: 36994298 PMCID: PMC10042519 DOI: 10.7759/cureus.35281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
A wide range of ocular complications may arise from the mosquito-borne illness, dengue fever. We report a case of isolated unilateral oculomotor nerve palsy due to complications of dengue fever. A 50-year-old male with serologically confirmed dengue fever presented with a sudden onset of double vision with left eyelid drooping and left eye outward deviation on his day 8 of illness. Ocular examination revealed binocular diplopia with complete left eye ptosis and restriction of all left eye movements except for abduction. His left eye pupil was 8 mm dilated with a negative relative afferent pupillary defect (RAPD). A clinical diagnosis of left eye oculomotor nerve palsy with pupil involvement was established. Urgent contrasted brain imaging tests were performed and revealed to be normal. He was managed conservatively and had complete resolution of symptoms with good vision recovery within 3.5 months. Cranial mononeuropathy may be one of the various complications following dengue fever, as demonstrated in this case report. As it is an uncommon presentation, there is a need to exclude other acute causes of cranial nerve palsy. Visual prognosis is still favorable with judicious monitoring and without any treatment of steroids or immunoglobulin.
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Thakur SK, Dubey S, Gupta S. Isolated abducens nerve palsy - A rare clinical presentation in dengue haemorrhagic fever. Trop Doct 2021; 51:611-612. [PMID: 33602052 DOI: 10.1177/0049475520983643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dengue fever is the most prevalent flavivirus infection in tropical and subtropical areas of the world. It is transmitted by the haematophagous mosquito Aedes aegypti, and it manifests clinically as classical dengue fever, dengue haemorrhagic fever and dengue shock syndrome. Rarely, dengue can be associated with neurophthalmic manifestations. We present the case of a 21-year-old woman, suffering from dengue with an isolated abducens nerve palsy.
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Affiliation(s)
- Sanjay Kd Thakur
- Professor, Department of Ophthalmology, Midnapore Medical College & Hospital, Kolkata, India
| | - Surabhi Dubey
- Postgraduate Trainee, Department of Ophthalmology, Midnapore Medical College & Hospital, Kolkata, India
| | - Somedeb Gupta
- Assistant Professor, Department of Ophthalmology, Midnapore Medical College & Hospital, Kolkata, India
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Martínez-Catalán N, Valencia M, Del Palacio M, Fernández-Jara J, Calvo E. Isolated spinal accessory nerve mononeuropathy causing winging scapula: an unusual peripheral nervous system manifestation of dengue fever. JSES Int 2020; 4:491-494. [PMID: 32939473 PMCID: PMC7479028 DOI: 10.1016/j.jseint.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Natalia Martínez-Catalán
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Maria Valencia
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Marta Del Palacio
- Department of Internal Medicine, Hospital Universitario Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Javier Fernández-Jara
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain
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Cerebral vasculitis and lateral rectus palsy - two rare central nervous system complications of dengue fever: two case reports and review of the literature. J Med Case Rep 2018; 12:100. [PMID: 29669602 PMCID: PMC5907410 DOI: 10.1186/s13256-018-1627-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/19/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Dengue fever is a common mosquito-borne viral illness with a clinical spectrum ranging from a simple febrile illness to potentially life-threatening complications such as dengue hemorrhagic fever and dengue shock syndrome. Dengue infection can affect many organs, including the central nervous system. The neurological manifestations reported in dengue infections are meningitis, encephalitis, stroke, acute disseminated encephalomyelitis, and Guillain-Barré syndrome. CASE PRESENTATION We report the cases of two interesting patients with confirmed dengue infection who presented with complications of possible central nervous system vasculitis and cranial nerve palsy. The first patient was a 53-year-old previously healthy Singhalese woman who developed acute-onset slurring of speech and ataxia with altered sensorium 1 day after recovery from a critical period of dengue hemorrhagic fever. Subsequent investigations revealed evidence of encephalopathy with brainstem ischemic infarctions. Her clinical picture was compatible with central nervous system vasculitis. She was treated successfully with intravenous steroids and had a full functional recovery. The second patient was a middle-aged Singhalese woman who had otherwise uncomplicated dengue infection. She developed binocular diplopia on day 4 of fever. An ocular examination revealed a convergent squint in the left eye with lateral rectus palsy but no other neurological manifestation. CONCLUSIONS Central nervous system vasculitis due to dengue infection is a very rare phenomenon, and to the best of our knowledge, only one case of central nervous system vasculitis has been reported to date, in a patient of pediatric age. Cranial nerve palsy related to dengue infection is also rare, and only a few cases of isolated abducens nerve palsy have been reported to date. The two cases described in this report illustrate the rare but important central nervous system manifestations of dengue fever and support the fact that the central nervous system is one of the important systems that can be affected in patients with dengue infection.
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Li GH, Ning ZJ, Liu YM, Li XH. Neurological Manifestations of Dengue Infection. Front Cell Infect Microbiol 2017; 7:449. [PMID: 29119088 PMCID: PMC5660970 DOI: 10.3389/fcimb.2017.00449] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS), peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.
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Affiliation(s)
- Guo-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Zhi-Jie Ning
- Jinan Infectious Diseases Hospital, Jinan, China
| | - Yi-Ming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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Mazliha M, Boo YL, Chin PW. Isolated unilateral sixth cranial nerve palsy: A rare presentation of dengue fever. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2016; 11:25-26. [PMID: 28461846 PMCID: PMC5405330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dengue fever is a common mosquito-borne viral infection endemic in tropical and subtropical countries. Neurological manifestations in dengue infection are relatively uncommon, and include encephalitis, encephalopathy, neuromuscular disorders and neuro-ocular disorders. Cranial mononeuropathy is a rare manifestation of dengue infection. A 40-year-old man was diagnosed with isolated, unilateral sixth cranial nerve palsy complicating dengue infection. The patient was managed accordingly, and full ocular recovery was observed. This was the first reported case of isolated sixth cranial nerve palsy associated with dengue fever in Malaysia. It is important for clinicians to consider dengue as a differential diagnosis in patients presenting with fever and sixth cranial nerve palsy.
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Affiliation(s)
- M Mazliha
- MBChB, MRCP Department of Medicine, Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor Darul Takzim, Malaysia.
| | - Y L Boo
- MD, MRCP Department of Medicine, Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor Darul Takzim, Malaysia.
| | - P W Chin
- MBBS, MRCP Department of Medicine, Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor Darul Takzim, Malaysia E-mail:
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