Epstein-Barr virus co-infection in a patient with dengue fever presenting with post-infectious cerebellitis: a case report

Abstract

IntroductionPost-infectious cerebellitis is an acute form of inflammatory encephalitis mainly limited to the cerebellum. It is commonly found in children, especially after viral infections such as Epstein-Barr virus. Post-infectious cerebellitis presents with acute onset dysarthria and ataxia. To the best of our knowledge, this is the first case report of post-infectious cerebellitis in a patient with both dengue and Epstein-Barr viral infection confirmed on serology.Case presentationA 43-year-old Sri Lankan Sinhala man presented with an acute febrile illness associated with thrombocytopenia. While being managed as uncomplicated dengue fever, our patient developed dysarthria, ataxia and cerebellar signs. Our patient's infectious disease screen was positive for both dengue and Epstein-Barr specific immunoglobulin M. A cerebrospinal fluid analysis was suggestive of viral meningoencephalitis while cerebrospinal fluid serology was positive for dengue immunoglobulin G. T2-weighted magnetic resonance images were consistent with post-viral cerebellitis. The patient was given full supportive care and he made an uneventful complete recovery.ConclusionThere have been no previously reported cases of post-infectious cerebellitis associated with both Epstein-Barr and dengue viral infections confirmed by serology. Our patient's clinical features and findings on the imaging studies were consistent with post-viral cerebellitis. This report highlights the need to screen for other possible more common etiologies of a particular presentation before coming to a specific diagnosis based on initial findings. Uncomplicated cases of cerebellitis can be successfully managed with appropriate supportive measures with good prognosis, as in this case.

Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever

“…We identified only isolated case reports of patients with dengue fever presenting with symptoms of cerebellitis ( 7 ) . Cerebellar involvement in dengue patients has been thought to be part of a postinfectious immune-mediated process ( 27 ) . However, there have been reports of cerebellar infection in patients with dengue, in whom pathological studies have revealed the presence of viral antigen in the cerebellar cells ( 28 ) .…”

Acute meningoencephalitis associated with echovirus 9 infection in Sri Lanka, 2009

“…To date, only a few studies on the aetiology of meningoencephalitis in Sri Lanka have been reported [Peiris et al, ; Peiris et al, ; Gunasekera et al, ; Karunarathne et al, ; Mori et al, ] due to limited diagnostic testing capabilities. Routine diagnostic services are available only for JEV by ELISA‐based IgM antibody detection in the public sector.…”

Spontaneously resolving cerebellar syndrome as a sequelae of dengue viral infection: a case series from Sri Lanka

“…Studies from India report similar findings4 5 and highlight some rare manifestations including mononeuropathies,1 acute disseminated encephalomyelitis,1 6 Guillain–Barré syndrome,1 acute viral myositis1 and hypokalaemic quadriparesis 7. Previously reported cases from Sri Lanka included a case of 6th nerve palsy8 and one of cerebellar syndrome due to dengue and Epstein–Barr virus coinfection 9. Dengue rarely leads to a cerebellar syndrome.…”