Acute transverse myelitis and subacute thyroiditis associated with dengue viral infection: A case report and literature review

Abstract

Abstract. Acute transverse myelitis is a rare manifestation of dengue infection. To the best of our knowledge, only 6 cases of acute transverse myelitis as a manifestation of dengue infection have been reported thus far. The present study described a case of acute transverse myelitis complicated with subacute thyroiditis 6 days after the onset of dengue viral infection. In addition, the available literature was searched to identify similar previous cases. Treatment with intravenous pulse methylprednisolone immunoglobulin plasmapheresis and physiotherapy resulted in partial recovery at 3 months post-infection. In conclusion, the involvement of dengue infection should be considered in patients who develop central nervous system manifestations during or after the recovery period of dengue infection. Furthermore, since methylprednisolone and immunoglobulin are effective during the active phase of the infection, prompt diagnosis and initiation of treatment are crucial.

Differences in Clinical and Laboratory Findings Among Graves’ Disease, Painless Thyroiditis and Subacute Thyroiditis Patients With Hyperthyroidism

“…In Japan, the ratio of women to men was 6, 4 and 7 in 1970s, 1980s and 1996-2004, respectively [12][13][14]. The incidence of subacute thyroiditis in women varied widely by region and time, which may be explained by the association of development of subacute thyroiditis with various bacterial and viral infections [15][16][17][18][19][20][21]. Seasonal changes of the incidence of subacute thyroiditis support our hypothesis [7].…”

“…Further, a significant association between subacute thyroiditis and infection has been reported [15][16][17][18][19][20][21]. Steroid levels increase immediately after stress such as infection in response to the stimulation of corticotropin-releasing hormone secretion by various cytokines [23].…”

Neurological Manifestations of Dengue Infection

“…In addition, inflammatory reactions in the CSF are found in most patients. TM/LETM in dengue is rarely encountered, and no more than 12 case reports are available (Renganathan et al, 1996 ; Leao et al, 2002 ; Kunishige et al, 2004 ; Seet et al, 2006 ; Chanthamat and Sathirapanya, 2010 ; Verma et al, 2011a ; Larik et al, 2012 ; Singh et al, 2013 ; Weeratunga et al, 2014a ; Fong et al, 2016 ; Mo et al, 2016 ; Mota et al, 2017 ).…”

“…Fong et al reported that a previously healthy 12-year-old girl with parainfectious-dengue TM and concomitant spinal epidural haematoma had good clinical recovery without surgical intervention after 6 months (Fong et al, 2016 ). It was shown that post-infection autoimmune reactions and direct infection are associated with transverse myelitis (Solomon et al, 2000b ; Sindic et al, 2001 ; de Sousa et al, 2014 ; Mo et al, 2016 ).…”

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

“…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 ( Figure 1). The remaining 25 studies were eligible and full text was assessed for inclusion in the final review [7,9,10,[12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Most of the studies were from Asia (76%; 19/25) and the rest from South America (24%; 6/25).…”