A 25-Year-Old Man Presenting With Dengue Encephalitis: A Case Report

Abstract

We present a case of a 25-year-old previously healthy man who came into our emergency department with decreased verbal output and fever. Patient came in febrile, tachycardic and tachypneic. Physical examination was essentially normal; however, patient was noted to be aphasic. Initial diagnostics were requested. Complete blood count (CBC) showed leukocytosis with white blood cell count of 15 × 10⁹/L and normal platelet count of 157 × 10⁹/L. Chest X-ray was normal, and so was the urinalysis. Leptospira IgG and IgM showed negative results. Patient was suspected to have bacterial meningitis. He was then given empiric therapy and was started with ceftriaxone and vancomycin. The patient was then referred to the neurology service where a magnetic resonance angiography of the intracranial vessels was made. Results were highly suggestive of viral encephalitis. Lumbar tap for cerebrospinal fluid analysis was performed showing negative test results for cryptococcal antigen, gram stain, acid fast stain, culture and susceptibility, tuberculosis (TB) culture, negative staining, herpes simplex virus 1 and 2, and TB polymerase chain reaction (PCR). Patient was referred to the infectious disease service and a repeat CBC was requested showing leukopenia and thrombocytopenia. Dengue duo was positive together with the CSF dengue RNA-PCR. Platelet went down to as low as 14 × 10⁹/L and patient was transfused with six units of platelet concentrate. Supportive therapy was given and daily monitoring of blood counts was made. The patient started to recover on the fifth day and completely recovered and discharged on the ninth hospital day with normal blood counts and no neurologic deficit.




Clin Infect Immun. 2020;5(1):10-13
doi: https://doi.org/10.14740/cii93