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Título

Guillaín-Barré Syndrome after Dengue Virus Infection, a rare neurological complication

RESUMO

Case: A 39-year-old man with a history of 10 days of fever, arthralgia and rash that evolved with nausea, vomiting and abdominal pain, admitted at the hospital because of worsening abdominal pain, liver dysfunction, increase in hematocrit and thrombocytopenia with positive serology for dengue (IgM). At the third day of hospitalization, patient started with paresthesia of both legs that rapidly progressed, distal weakness, areflexia, bilateral facial paralysis, dysarthrophonia and dysphagia. The analysis of cerebrospinal fluid showed cytological protein dissociation (1 cell and 58 proteins). Considering the clinical and laboratory features the diagnosis was Guillain-Barré Syndrome (GBS). Then, we referred him to the intensive care unit and intravenous immunoglobulin (IgIV) for five day was the treatment. At the second day of IgIV he evolved with dysautonomia (heart rate instability and urinary retention) associated with worsening of the bulbar symptoms with necessity to orotracheal intubation. He had clinical complications such as ventilator-associated pneumonia receiving broad-spectrum antibiotics and evolved with pseudomembranous colitis because of the antibiotics, but presenting a good treatment response. Given the slow recovery and prolonged hospitalization, he underwent tracheostomy and gastrostomy, being discharged after 60 days of hospitalization. Discussion: GBS is a rare presentation of dengue infection. The most common neurologic manifestations associated with dengue virus (DENV) infection include headache, encephalopathy and seizures. Other neurologic syndromes reported include acute pure motor weakness, mononeuropathies, polyneuropathies, stroke and transverse myelitis. A cohort study evaluated the increasingly incidence of neurologic complications of DENV and demonstrated that clinical and laboratory parameters like higher body temperature, liver dysfunction, increase in hematocrit and thrombocytopenia are independent predictors of neurologic complications, those changes were found in our patient what is in agreement with the literature. Final comments: the incidence of GBS associated with dengue fever is still unknown and in the literature, there are just few isolated case reports. In Brazil, dengue fever is endemic and early recognition of neurological conditions that may be associated with this infection and being attention to predictors that increases the risk of these complications is very important in order to prevent bad outcomes.

Palavras Chave

Dengue fever; Guillaín-Barré Syndrome; neurological complications.

Área

Doenças Neuromusculares