Dengue Encephalitis in a Pediatric Patient: An Unusual Presentation of a Common Disease in Endemic Areas

To the Editor: We present a case of dengue encephalitis in a 16-year-old Colombian patient, underscoring the neuroinvasive potential of dengue virus (DENV) in endemic areas and the critical need for early diagnosis. DENV is widespread in tropical regions, with Aedes mosquitoes (Aedes aegypti, Aedes albopictus) acting as vectors.1 In Colombia, approximately 85.4% of municipalities are affected by the vector, with a substantial rise in dengue cases reported during 2024.2 The patient, with a recent travel history to La Palma, Cundinamarca, presented with a week-long malaise, progressing to neurological symptoms, including seizures, and altered consciousness. Initial laboratory results indicated thrombocytopenia and elevated liver enzymes, with a positive dengue IgM, confirming DENV infection. A lumbar puncture and extensive infectious workup ruled out other causes, attributing encephalitis to DENV. Management in the pediatric intensive care unit involved anticonvulsants, corticosteroids and supportive care, resulting in neurological improvement, although cognitive deficits persisted, requiring ongoing rehabilitation. This case highlights the need for awareness of DENV’s neuroinvasive manifestations and suggests that dengue should be considered in patients presenting with fever and neurological symptoms in endemic areas.3 Timely serologic and molecular testing is vital for early diagnosis, and management should focus on symptomatic control and stabilization in an intensive care setting. Immunomodulators, such as corticosteroids, may benefit patients with immune-mediated complications. This case reinforces the importance of diagnostic vigilance and early intervention to mitigate neurological complications of dengue.4Table 1 displays the principal series of neurologic complications of dengue. TABLE 1. - Reported Neurological Manifestations in Dengue Patients Across Various International Studies Number of Patients Percentage of Neurologic Manifestations Type of Neurologic Involvement Country, Authors and Year Additional Comments 498 5.6% Paresthesia (3.8%), encephalopathy (1%), meningoencephalitis (0.4%), seizures (0.8%), meningoencephalitis (0.4%), paresis (0.4%) and encephalitis (0.2%). Brazil, Tassara et al, 20175 Case series in endemic area; predominant DENV-3; varied symptoms, including altered consciousness. 484 9.26% CNS involvement (62.2%); encephalitis (33%) and encephalopathy (22%). PNS involvement 37.8%; myelitis (7%), GBS (9%) and amyotrophic neuralgia (7%). Others: myositis (13%) and hypokalemic paralysis (9%). India, Sahu et al, 20146 Prospective cohort in endemic population reporting increased incidence and spectrum of neurological complications associated with DENV. 401 13.5% Encephalitis (51.8%), meningitis (33%), seizures (11.1%) and acute facial paralysis/Guillain-Barré syndrome (3.7%). Jamaica, Jackson et al, 20087 Case report in endemic population; symptoms observed include seizures and altered consciousness. 225 5.4% Altered level of consciousness (58.3%), seizures (41.6%), neck stiffness (16.6%), decerebration (16.6%) and hemiplegia/paresis (33.3%). Pakistan, Wasay et al, 20088 Case series in endemic area. 11 100% Encephalitis, tonic-clonic seizure (72.7%), headache (18.1%), altered consciousness (27.2%), ataxia (18.1%) and paresis (9%). Colombia, Castellano et al, 20213 Case series in pediatric patients in the endemic area; need for further research in this area. CNS indicates central nervous system; GBS, Guillain-Barré syndrome; PNS, peripheral nervous system.