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Título

Dengue-associated demyelinating lesions - CASE REPORT

RESUMO

Case Report: Male patient, 21 years old, presented with myalgia, headache and fever for 3 days and spontaneous resolution. After 7 days of the resolution of the previous condition, he started to have paresthesia in the lower limbs, evolving in a subacute way with urinary retention. Referred to the emergency service with progressive worsening of strength in the upper limbs after 24 hours. After admission, the patient began to present diplopia and excessive sleepiness. In the initial exams, the only laboratory alteration that called attention was a serology for Dengue (positive IgM and IgG). CSF analysis showed pleocytosis (112 cells with lymphocytic predominance) and protein analysis (194mg/dl, presence of a suggestive band in the gamma region). Magnetic resonance imaging of the Thoracic Spine showed a hyperintense centromedullary lesion on T2/stir, affecting practically its entire length with spots enhancement by gadolinium. Brain MRI with signs of infratentorial and supratentorial lesions, without gadolinium enhancement. Lesions were not characteristic of ADEM. It was decided to perform pulse steroid therapy with Methylprednisolone 1g for 5 days, with progressive improvement and complete resolution of the condition. Discussion: The Dengue virus can affect the neurological system directly by viral invasion or indirectly with immune-mediated reactions. Complications may arise during a feverish period or during convalescence, and may manifest as Encephalitis, Stroke, Myalgia, Guillain Barré Syndrome, Myositis, Hypokalemic Paralysis, Myelitis and Acute disseminated encephalomyelitis (ADEM). In the case above, the manifestations started 7 days after the febrile period, suggesting a molecular mimicry reaction between the pathogen and the host's myelin. There are few cases in the literature relating longitudinally extensive myelitis associated with dengue, with emphasis on a study in the Amazon region of 51 cases, with favorable evolution and recovery of deficits in 95% of patients. Other cases correlate dengue with brain involvement, most cases occurred during the recovery phase of uncomplicated dengue. Final Comments: Dengue is the most prevalent arbovirus in the world, and Brazil recorded an increase of 113.7% in the first months of 2022 compared to the previous year. Consequently, they link an alert to the neurological manifestations associated with this infection that can be serious and potentially fatal.

Palavras Chave

Dengue, Myelitis, ADEM, arbovirus

Área

Neuroinfecção