Dados do Trabalho

Título

Dengue Encephalitis: Image similar to Herpetic Encephalitis

Introdução/Fundamentos

Encephalitis is one of the most common neurological complications of dengue infection. In 50% of patients presenting with this complication, cerebrospinal fluid analysis is normal, but there may also be lymphocytic pleocytosis; in most cases the Magnetic Resonance imaging is normal, or may show focal parenchymal abnormalities, usually non-specific.

Objetivos

To report a case of dengue viral encephalitis accompanied at a private Health Service in the state of Paraná, Brazil.

Caso

I.T.T., female, 60 years old, hospitalized for confusion and fever initiated one week before admission. The patient presented with difficulty retaining new information and disorientation in time and space. There was no associated convulsive episodes, and no previous comorbidities or drug allergies. On examination, Glasgow 14 because of confusion, reverberation, isophotoreactive pupils, with no other focal deficits, and fever of 38.2º C. Cerebrospinal fluid (CSF) analysis showed pleocytosis (80 leukocytes/ mm3) with predominance of monomorphonuclear cells, normal glucose, proteinorrhage (68mg/ dl), nonreactive VDRL and negative bacterioscopy. Electroencephalogram with no abnormalities. The patient underwent magnetic resonance imaging, which showed alteration of the signal affecting the left hippocampal region with extension to the temporal pole and homolateral insular cortex, with slight diffusion restriction, findings consistent with the inflammatory/infectious process found in herpetic encephalitis. Due to the description of the image and serology at the time still in progress, intravenous acyclovir treatment was performed. Subsequent to the onset of Acyclovir, research results negative for Herpes CSF type 1 and 2, Varicela Zoster, Epstein-Barr and Enterovirus were received, as well as serum serology IgM reagent and IgG non-reagent IgG for Dengue, configuring Dengue Encephalitis. Patient was discharged after eleven days of hospitalization, keeping only difficulty to retain new information.

Conclusões/Considerações finais

The case described here corresponds to a dengue encephalitis picture confirmed by serology, whose brain image is atypical, since it is usually normal or with non-specific focal changes. Magnetic resonance imaging, in this case, showed alterations very similar to herpetic encephalitis, which is usually presented with ischemic lesions in the temporal lobe.

Palavras-chave

encephalitis, dengue, neurologic manifestations, diagnosis

Área

Clínica Médica