Acute Transverse Myelitis as a Rare Neurological Complication of Dengue Fever: A Case Report

Abstract Background/ Introduction Dengue is a blood borne disease having a consistent presentation of fever, myalgia and thrombocytopenia while neurological involvement in dengue is rarely reported. This case report presents a rare case of dengue induced acute transverse myelitis (ATM) emphasizing the importance of early diagnosis and prompt treatment to prevent permanent neurological deficits. Case presentation The patient presented with fever, retro orbital pain and vomiting. A blood sample for dengue serology including IgM and IgG were positive. Later on, he developed sudden onset of paraplegia of lower limbs and loss of sensations below the level of umbilicus. Neurological examination revealed a power of zero in both lower limbs, positive Babinski sign, brisk lower limb reflexes and loss of control of bowel and bladder. Magnetic resonance imaging of the spinal cord revealed diffuse hyper intense signals. A possible diagnosis of ATM was made due to concurrent dengue infection and lack of other findings suggesting a diagnosis other than dengue. He was treated with IV methylprednisolone and tocilizumab and his condition started improving gradually. Conclusion This case underscores ATM as a rare yet reversible neurological complication of dengue fever. Early recognition and diagnosis through neuroimaging and exclusion of other causes, followed by timely initiation of high-dose corticosteroids and immunomodulatory therapy, can lead to favorable outcomes. Awareness of this association is very crucial in endemic regions of dengue to ensure prompt treatment and optimal recovery.