Title: Acute Hemorrhagic Adem - An Unusual Presentation of Dengue Treated with Plasmapheresis
Authors: Dr Ravi Sharma, Dr Rajiv Kumar Bansal
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.21
Abstract
Neurological manifestations after dengue are not very common& acute disseminated encephalomyelitis (ADEM) following dengue infections is still more infrequent. We report a male, 10 year old who developed Hemorhhagic ADEM after 7-8 days of dengue illness. The disease was confirmed by detection of dengue IgM antibodies in serum & absence of dengue PCR & IgM in CSF. MRI brain showed hemorrhagic encephalitis involving bilateral thalami, posterior limbs of internal capsule, adjacent lenticular nuclei, left hippocampus, right temporoparietal lobes, right periventricular white matter, midbrain, pons, medulla & bilateral cerebellar peduncles. Csf analysis showed 03cells/ protein 73 mg/dl. Patient was treated with cerebral decongestants, antiepileptics & iv methylprednisolone (MPS) for 5 days. In view of slow clinical recovery after 3 doses of iv MPS, 2nd line immunotherapy – plasmapheresis was initiated & patient was treated with 4 cycles of plasmapheresis. Patient responded on plasmapheresis, was extubated, GCS improved to 9-10/15, residual sequale of mutism, tendoachilles contracture & poor cognition were seen. Therapeutic intervention with plasmapheresis resulted in rapid recovery.
Keywords: Acute disseminated encephalomyelitis, dengue, magnetic resonance imaging, plasmapheresis.
References
1. 1. Rajajee S, Mukundan D (1994) Neurolo-gical manifestations in dengue hemorr-hagic fever. Indian Pediatr 31: 688-690.
2. Puccioni-Sohler M, Orsini M, Soares CN (2012) Dengue: a new challenge for neurology. Neurol Int 4: e15.
3. Varatharaj A (2011) A case definition is needed for dengue encephalitis (response to Soares et al., JNS 2011). J Neurol Sci 306: 164.
4. Gera C, George U (2010) Acute dissemin-ating encephalomyelitis with hemorrhage following dengue. Neurol India 58: 595-596.
5. Brito CA, Sobreira S, Cordeiro MT, Lucena-Silva N (2007) Acute dissemin-ated encephalomyelitis in classic dengue. Rev Soc Bras Med Trop 40: 236-238.