A Case Report: Dengue Encephalitis - A Rare Entity of Dengue Virus Infection

Abstract

Dengue encephalitis is a rare entity in central nervous system manifestation of dengue virus infection. We reported a case of 20-year-old male presented with high fever, diarrhea and vomiting for 3 days. On the fourth day, he developed a confusional state. The preliminary results of the blood test had not been clearly abnormal. The brain CT scan showed isodensity lesion withmperilesional edema at the thalamus on both sides. The cerebrospinal fluid showed abnormally high protein and normal sugar level with minimal RBC. Empirical therapy was started with ceftriaxone 4 g/d and acyclovir 1500 mg/d. One day later, the patient developed coma and seizures. Repeated blood tests revealed thrombocytopenia and hepatitis. The patient was tested for dengue serology in blood and dengue NS1 antigen was demonstrated. Qualitative polymerase chain reaction for type 2 dengue virus and dengue virus IgG were also found in the CSF to confirm the diagnosis. The repeated CT brain showed isodensity lesion with perilesional edema at the thalamus on both sides as before, and also found at brainstem and cerebellum. Dexamethasone 32 mg/d and anticonvulsant were administered. Five days later, he was fully recovered without any neurological deficits. In endemic countries, dengue should be considered in patients presenting with fever and acute neurological manifestations.