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Images in Neurology |

Encephalomyelitis Associated With Dengue Fever ONLINE FIRST

Yara Dadalti Fragoso, MD, MSc, PhD1; Joseph Bruno Bidin Brooks, MD, MSc1
[+] Author Affiliations
1Multiple Sclerosis Reference Center, Department of Neurology, Universidade Metropolitana de Santos, São Paulo, Brazil
JAMA Neurol. Published online September 12, 2016. doi:10.1001/jamaneurol.2016.1416
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This case report describes a man in his 20s who was admitted with a clinical demyelination syndrome and a recent diagnosis of dengue fever.

A man in his 20s was referred to our multiple sclerosis reference center with a clinical demyelination syndrome. The patient was otherwise healthy until 2 weeks earlier, when he was diagnosed with dengue fever. For 5 days, the patient had a high temperature and a skin rash. The results of blood testing showed thrombocytopenia (70 × 103/μL platelets [to convert to × 109/L, multiply by 1]) and were IgM-positive for dengue fever. The patient started to recover from this viral infection, but 10 days later, he developed diplopia, optic neuritis, paraparesis, paresthesia, hyperreflexia in his lower limbs, abnormal proprioception, urinary incontinence, vertigo, and gait ataxia. The patient became bedridden and mentally confused and began sleeping excessively.

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Figure.
Magnetic Resonance Imaging of the Brain and the Cervical Spinal Cord

Arrowheads point to demyelination areas in the brainstem, cerebellar peduncle, corpus callosum, and spinal cord (C3-C6). Punctuate lesions of the corpus callosum in the sagital T2-weigted fluid-attenuated inversion recovery magnetic resonance image are indicative of focal demyelination. Other areas did not show lesions identifiable by magnetic resonance imaging.

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