Guillain-Barré syndrome in the course of dengue: case report

Abstract

-This case report describes the findings of a 45-year-old white woman from Brazil, who developed myalgia, fever and macular rash. She was diagnosed as having dengue, based on clinical manifestations and specific IgM titers. One week after the first symptoms of dengue, the patient developed muscle weakness, followed by tetraplegia with areflexia, and respiratory insufficiency. The electromyography had evidence of demyelinating neuropathy and the cerebrospinal fluid showed albuminocytologic dissociation. These neurologic findings were consistent with the diagnosis of Guillain-Barré syndrome. The patient was treated with immunoglobulin and metylprednisolone. Mechanical ventilation was started one week after hospital admission and maintained for four weeks. After six weeks of hospitalization the patient was discharged from the hospital on wheel chair, presenting mild muscle weakness and loss of patellar and ankle reflexes. When the patient was seen at the outpatient service three weeks after hospital discharge she was able to walk with help. This case report suggests a possible association between dengue and Guillain-Barré syndrome.KEY WORDS: Guillain-Barré syndrome, dengue, radiculoneuritis. Síndrome de Guillain-Barré no curso de dengue: relato de casoRESUMO -Este relato de caso descreve os achados de uma mulher de 45 anos, branca, que desenvolveu mialgia, febre e eritema macular. Ela recebeu o diagnóstico de dengue, tomando por base os achados clíni-cos e títulos específicos de IgM. Uma semana depois do início dos primeiros sintomas de dengue, a paciente desenvolveu fraqueza muscular, tetraplegia e insuficiência respiratória. A eletromiografia mostrou evidên-cia de uma neuropatia desmielinizante e o liquor apresentou quadro de dissociação albuminocitológica. Os achados neurológicos foram consistentes com o diagnóstico de síndrome de Guillain-Barré. A paciente foi tratada com imunoglobulina e metilprednisolona. Ventilação mecânica foi iniciada uma semana após a admissão hospitalar, sendo mantida por quatro semanas. Após seis semanas de internamento a paciente teve alta em cadeira de rodas, apresentando fraqueza muscular e perda dos reflexos patelar e aquileu. Quando a paciente foi vista no ambulatório, três semanas após a alta hospitalar, ela já era capaz de andar com ajuda do acompanhante. Este relato de caso sugere uma possível associação entre dengue e síndrome de Guillain-Barré. PALAVRAS-CHAVE: síndrome de Guillain-Barré, dengue, radiculoneurite.

Oligosymptomatic dengue infection: a potential cause of Guillain Barré syndrome

“…Neurological symptoms developed between four to nineteen days after the onset of dengue picture. All of them presented tetraparesis and, except for the case described by Santos et al 16 , had good recovery. The infection was suspected and confirmed in all of them, but only in one case the immunological test to dengue in the CSF was done 14 , and it was negative.…”

“…Guillain Barré syndrome has been described by isolated reports. In our literature revision we found seven cases reports of GBS associated to dengue infection [13][14][15][16][17][18] . There were three children and six adults, ages ranging from one and half to 46 years old.…”

Dengue with hypokalemic periodic paralysis: A case report and review

“…They also observed that potassium supplementation resulted in rapid improvement of symptoms. Santos et al [6] reported GB syndrome in the course of dengue. The clinical profile of dengue is changing, and the neurological manifestations are reported more frequently.…”

“…Widodo et al [2] observed prevalence of hypokalemia in 23% (n = 105) of the hospitalised patients with infectious disease and Kalita et al studied 16 patients with dengue fever with quadriparesis, in seven, the pure motor quadriparesis was due to myositis. [6] Hypokalemia in association with infectious diseases, particularly in dengue fever, has been reported. Hypokalemic paralysis secondary to chikungunya fever has also been documented.…”

Guillain-Barré syndrome and dengue fever: report on ten new cases in Brazil

“…A recent report on three cases in New Caledonia showed findings similar to those reported here 3 , while fatal cases have recently been described in India 4 and Pakistan 5 . In Brazil, which has been an endemic region for dengue fever for over two decades, very few cases of associated GBS have been reported 6,7,8,9 . These authors believe that GBS in association with dengue fever may be underdiagnosed, even in endemic areas.…”