Meningoencephalitis during the course of dengue infection: a case report

Abstract

Introduction: Neurological complications associated with dengue occur in 0.5% to 20% of hospitalized patients and can range from encephalopathy and encephalitis to immune-mediated syndromes, among others. Central nervous system involvement has been demonstrated through the detection of the virus in brain tissue via immunohistochemistry in fatal cases of dengue encephalopathy, as well as through polymerase chain reaction (PCR) and effective IgM testing of cerebrospinal fluid in patients with dengue encephalitis.

Objective: To present an unusual case of meningoencephalitis likely resulting from dengue infection.

Case report: A 27-year-old patient from a Colombian municipality located 300 meters above sea level sought medical attention for a four-day clinical presentation involving myalgia, arthralgia, diarrhea, mesogastric abdominal pain, cough, dyspnea, and fever reaching 40°C. The day before the consultation, neurological symptoms appeared, including headache, drowsiness, incoherent speech, and irritability, alongside an episode characterized initially by upper-limb automatisms, a fixed stare, and detachment from the surroundings, followed by a confusional state and an inability to follow commands. Paraclinical studies revealed moderate thrombocytopenia and cerebrospinal fluid findings of lymphocytic pleocytosis and elevated protein levels. Serum IgM testing for dengue yielded a reactive result, leading to a diagnosis of meningoencephalitis associated with severe dengue. Subsequently, following symptomatic management and inpatient monitoring, the patient showed a favorable clinical course and made a full recovery.

Conclusions: Early recognition of dengue-associated encephalitis is crucial for reducing the risk of associated complications. In endemic areas, this condition should be considered in the differential diagnosis of patients with neurological manifestations, despite its low frequency of presentation.