A Rare Case of Dengue Encephalitis with Raised Procalcitonin

Abstract

Patient: Male, 65-year-old Final Diagnosis: Dengue encephalitis Symptoms: AMS Medication:— Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare co-existance of disease or pathology Background: Dengue virus is a common arbovirus with uncertain neurotropism. Dengue encephalitis is a rare but fatal manifestation of severe dengue. Diagnosis requires high clinical suspicion. It should be routinely considered in patients with encephalopathy, especially in countries where dengue virus is endemic. Unlike other forms of severe dengue, the typical warning signs and biochemical derangements are not reliable markers for dengue encephalitis. Alternative biochemical markers of dengue encephalitis are needed. Case Report: We present a case of dengue encephalitis with distinctly raised procalcitonin (13.2 μg/L), in the absence of the typical warning signs and biochemical derangements of severe dengue. The patient was a 65-year-old man with fever and sudden loss of consciousness in the absence of other localizing signs/symptoms. Inflammatory markers were raised, with findings of leptomeningeal enhancement on brain computed tomography suggestive of meningoencephalitis. Septic workup was unremarkable (normal renal and liver functions, negative blood and urine cultures). The typical neurotropic microorganisms were not detected in the cerebrospinal fluid. On day 4 of admission, the patient reported abdominal pain and hematuria with a new onset of bicytopenia. Subsequent investigations for dengue infection were positive for serum dengue NS1 antigen and dengue RNA (type 2 strain) in cerebrospinal fluid, confirming the diagnosis of dengue encephalitis. The patient was managed supportively and experienced full clinical recovery. Conclusions: Dengue encephalitis is a rare condition with nonspecific biochemical and imaging abnormalities. We demonstrated that a raised procalcitonin level can occur in the setting of dengue encephalitis. In endemic countries, this finding may prompt further investigations for dengue encephalitis in patients with meningoencephalitis.

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“…Por otro lado, es importante hacer la evaluación de la alteración del sensorio luego de un adecuado manejo de fluidos y resuelta la hipotensión, puesto que la incidencia del compromiso neurológico en el dengue es hasta en el 20% de los casos y en la infección por virus del dengue se ha reportado pacientes que presentaron encefalitis por dengue en niños, jóvenes y acianos (5)(6)(7)(8) .…”

Endothelial damage and cardiac dysfunction in the pathophysiology of severe dengue in adults

“…The pathogenesis of neurological involvement in dengue is also still not well understood. Although cerebrospinal fluid analyses have demonstrated viral invasion with isolation of dengue virus and specific antibodies [47,49], the varied presentation and neurological syndromes associated with dengue illness suggest underlying mechanisms to be complex and may be due to a combination of factors such as changes in vascular permeability, direct viral cytopathic effects, and post-infectious immune mediated complications.…”