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Título

Guillain-Barré Syndrome following acute Dengue infection: a case report

RESUMO

In February 2022, a 20 year old woman was admitted with a 19-day history of ascending tetraparesis and paresthesia. 30 days after admission, she presented with cough, nasal congestion, odinophage, and tested negative for covid-19.
Upon hospital admission, the patient was unable to walk without help. She was conscious, well oriented and had normal vital signs. Neurological examination revealed global hypotonia, arreflexy and severe reduction of strength in the bilateral lower limbs. In upper limbs, she had hyporelexia, moderate lower limb weakness bilaterally, and global involvement of deep sensitivity, her neck muscle strength was reduced and she had right peripheral facial palsy.
Initial laboratory exams were unremarkable. Cerebrospinal fluid study (CSF) showed protein-cytological dissociation and Electroneuromyography (ENMG) revealed a demyelinating polyradiculoneuropathy pattern. The patient was treated with 5 cycles of plasmapheresis. By the end of the cycles she was able to walk without help.
This patient was diagnosed with Guillain Barre Syndrome (GBS) in its acute inflammatory demyelinating polyneuropathy form (AIDP). Additionally, she was tested for dengue-specific IgM in the CSF, providing the association of GBS AIDP with dengue fever (DF).
Symptoms of GBS may begin a few weeks after a febrile infection. Though there are well established preceding infective agents, arbovirus as aetiological factors for GBS are uncommon. Studies show that the annual incidence of GBS after arbovirus infection is 0.24 cases per 100 thousand inhabitants. Arbovirus infections are frequent, but they rarely involve the nervous system. In this patient case, the presence of a positive dengue-specific IgM in CSF, following neurological manifestations, patterns of ENMG and the typical CSF findings, supported the association of GBS and DF.
Although GBS associated with DF is a rare condition, it's a serious neurological complication that remains underdiagnosed. Strategies for notification and investigation should be implemented. Our findings highlight the importance of further studies to better understand this condition and raise awareness amongst clinicians.