Japanese Encephalitis Associated With Quadriplegia: The First Reported Case of Nepal

Japanese encephalitis (JE), a viral infection transmitted by Culex mosquitoes, primarily affects children and adolescents in endemic regions, with severe cases leading to life-threatening neurological complications. We report the first documented case of JE-associated quadriplegia in Nepal, involving a 19-year-old male presenting with high-grade fever, altered sensorium, vomiting, and profound motor dysfunction. Neurological examination confirmed quadriplegia, while cerebrospinal fluid analysis revealed mildly elevated protein and glucose levels, and brain imaging was unremarkable. Diagnosis was confirmed by serum JEV-specific IgM antibodies. The patient received supportive care, including hydration, antipyretics, prophylactic antibiotics, and corticosteroids, leading to significant motor function improvement over 2 weeks of hospitalization. This case presents the importance of early diagnosis, timely intervention, and rehabilitation in managing severe JE manifestations and highlights the critical need for adherence to national JE vaccination schedules to prevent such debilitating outcomes in endemic areas.