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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 01): S1-S52
DOI: 10.1055/s-0044-1789428
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Immune-mediated neurological complications and dengue

João Henrique da Matta Clementino
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Alex Eduardo Silva
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Marlos Aureliano Dias de Sousa
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Ana Luisa Rufino de Sousa
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Amanda Soares Pimenta
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Daniela Aparecida Lima Viana
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Elisangela Ferraz Pazinato
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Giovani Zago Borges
1   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
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    Address for correspondence: João Henrique da Matta Clementino (email: joaoclementino96@hotmail.com).

    Abstract

    Case Presentation: Case 1: After 15 days of dengue infection confirmed by detection of the NS1 antigen in the blood, a 50-year-old woman started to present intense asthenia, paresthesia, and ascending paresis. She underwent electroneuromyography, which was compatible with acute demyelinating polyradiculoneuritis – Guillain-Barré Syndrome, and liquor with proteinocytological dissociation. After treatment with human immunoglobulin, she showed significant improvement in symptoms. Case 2: A 23-year-old man had dengue virus infection confirmed by serology. After 20 days, he evolved with paresthesia and upward paresis, hypoesthesia with a sensory level on T1, and urinary retention. On a magnetic resonance imaging scan of the skull and cervical spine, multiple lesions with hypersignal in T2/FLAIR were evident in the white, supra- and infratentorial substance, in the brainstem, and in the cervical and thoracic spinal cord, with acute disseminated encephalomyelitis (ADEM) being the first diagnostic hypothesis. In the cerebrospinal fluid, pleocytosis, proteinorrachia, and IgM immunoglobulin reagent for the dengue virus were observed.

    Discussion: The neuropathogenesis of dengue infection is due to the direct invasion of the virus into the central nervous system, immune-mediated reactions, or metabolic changes. The neurological complications of dengue include encephalopathy, meningitis, myelitis, ADEM, optic neuromyelitis, optic neuritis, Guillain-Barré syndrome and neuro-ophthalmic complications. After infection by the dengue virus, our patients had neurological complications in the peripheral and central nervous system which, in both cases, are probably secondary to the immune-mediated mechanisms.

    Final Comments: The dengue virus is considered non-neurotropic; however, the presence of viral particles in the cerebrospinal fluid, as well as damage to the blood-brain barrier, suggest viral neurotropism. Acute febrile diseases with neurological manifestations should be included in the diagnostic investigation, especially in endemic regions of arboviruses, such as tropical and subtropical countries.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    02 October 2024

    © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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