An Unusual Presentation of Dengue Fever: Association with Longitudinal Extensive Transverse Myelitis

Post-Viral Longitudinally Extensive Transverse Myelitis: A Case Report

Longitudinally extensive transverse myelitis is a rare neurological manifestation caused by dengue infection. Here, we describe the uncommon presentation of a 24-year-old male with fever and maculopapular rash followed by flaccid quadriparesis with acute urinary retention. Magnetic resonance imaging of the whole spine with contrast revealed a long-segment ill-defined hyperintense signal noted in the cord. The patient was managed conservatively with intravenous steroids and later intravenous immunoglobulins. The patient is on regular follow-up and doing well. Currently, the patient is on tablet prednisolone with a tapering dose.

Risk of Transverse Myelitis Following Dengue Infection: A Systematic Review of the Literature

INTRODUCTION

Dengue virus (DENV) is one of the most common arbovirus diseases, with a wide spectrum of presentation. Spinal cord involvement in dengue infection (DF) is rare. However, the risk of transverse myelitis (TM) following Dengue has not been systematically assessed.

METHODS

We undertook a systematic review of published English literature from January 1974 to December 2017 to assess risk of TM and outcomes following DF. Data sources included EMBASE, MEDLINE, Cochrane library, ISI web of knowledge, conference proceedings and references within identified articles.

RESULTS

We identified 242 potential studies, 62 were duplicates. A further 136 were excluded on the basis of title and abstract and 19 studies did not meet the eligibility criteria on full text screening. We included 25 publications involving 2672 cases of DF. A small proportion (10.8%, (289/2672)) had neurological complications, of which 2.3% (61/2672) was TM. For articles reporting epidemiological data, the neurological complication was twice in males compared to female 67.7% (130/192) vs. 32.7% (62/192) and 1.5-fold increase TM for males 59.3% (32/54) vs 40.7% (22/54). The mean age at presentation was 33.1years (range 0.75⁻61), with onset at 11.7days. The method of diagnosing TM due to DF was mainly IgM seropositivity 92% (n = 23/25) and the commonest treatment modality was steroid 78.3% (n = 18/23). Only half had full recovery 50.8% (n = 31/61). There was no mortality following dengue, however, the crude case fatality rate following TM was 3.3% (n = 2/61).

CONCLUSION

This review highlights the risk of TM following dengue. Although neurological complications are rare, especially TM, once set in, it is associated with a significant morbidity.

Beyond thrombocytopaenia, haemorrhage and shock: the expanded dengue syndrome

Dengue infection classically presents with fever, thrombocytopaenia, and varying degrees of plasma leakage, giving rise to shock. However, a myriad of other manifestations, involving the cardiovascular system, the nervous system, the liver, the kidneys, the gut and the haematological system have been reported in dengue. This review summarizes these varied presentations.

Myelitis and cauda equina involvement following dengue fever. A case report and review of the literature

Dengue fever (DF) is a common arbovirosis in tropical and subtropical countries and may be associated with a wide range of neurological complications. We describe a 41-year-old man who developed weakness in the right arm and lower limbs, paresthesia in the upper and lower limbs, and sphincter disturbance four weeks following DF. Examination disclosed a wheel-chair bound patient with urinary catheter, areflexia in the lower limbs, and a sensation level at T10. Spinal magnetic resonance imaging showed diffuse lesions with contrast-enhanced areas extending from the medullary-cervical junction to the conus medullaris and cauda equina. A review of the literature reveals that this is the first report of clinical and imaging signs of myeloradiculitis with cauda equina involvement following DF infection.