Post-Dengue Encephalopathy and Parkinsonism

Abstract

Parkinsonism as a neurologic manifestation of dengue infection is rare with only 1 reported case in an adult patient. We report a case of a 6-year-old child with self-limiting post-dengue encephalopathy and Parkinsonism. This is the first reported pediatric case of post-dengue Parkinsonism and expands the neurologic manifestations associated with dengue infection in children. Clinicians should consider the possibility of post-dengue Parkinsonism in children with a history of pyrexia from endemic areas of dengue.

Case Report: Dengue Virus–Triggered Parkinsonism in an Adolescent

“…6 A review of the published literature in "Pubmed," "Google Scholar," and other electronic databases revealed only four cases of parkinsonism triggered by dengue viral infection till now. Among these four cases, only one case reported by Fong et al 4 was in the pediatric age-group. A comparison of clinical features of all five cases, including the index case, has been shown in Tables 1 and 2.…”

“…Furthermore, parkinsonism secondary to dengue virus infection is uncommon, with only three published case reports in adults and one in children. [3][4][5] We describe a 13-year-old, pre-morbidly normal boy, who developed Parkinsonism after dengue infection. We also did a comparative review of all published cases of dengue-induced parkinsonism in children and adults.…”

Neurological Manifestations of Dengue Infection

“…Neurological complications recorded in pediatrics include ADEM (Kamath and Ranjit, 2006 ), hepatic encephalopathy (Kamath and Ranjit, 2006 ), acute childhood myositis (Ahmad et al, 2007 ), hemiconvulsion-hemiplegia-epilepsy (Gastaut et al, 1960 ; Saini et al, 2017 ), parkinsonism (Fong et al, 2014 ), ischemic stroke due to dengue vasculitis (Nanda et al, 2014 ), sub-arachnoid hemorrhage (Kamath and Ranjit, 2006 ), and transverse myelitis (Fong et al, 2016 ). Most cases achieve satisfactory recovery after timely treatment (Kankirawatana et al, 2000 ; Cam et al, 2001 ; Kamath and Ranjit, 2006 ).…”

Neurologic manifestations of the neglected tropical diseases

“…The most common was hypokalemic quadriparesis, followed by myositis and encephalitis. Other less commonly reported conditions include ischemic stroke, lumbosacral plexopathy, and mononeuropathy, as well as post-infectious GuillainBarré syndrome, acute disseminated encephalomyelitis, and parkinsonism [122,123]. Although diagnostic criteria for dengue encephalitis have been proposed, they are controversial since detection of dengue viral RNA and specific IgM antibodies in the CSF may be disease-course dependent and diagnostic tests are inconsistently available in endemic regions [124,125].…”