Dengue fever with papilledema: a case of dengue-3 virus infection in central nervous system.
OBJECTIVE
Neurological manifestations of dengue fever are rarely reported during acute illness and clinical presentation commonly observed is of acute encephalitis or one of the post-infectious immune mediated manifestations. We describe a case of dengue fever having mild encephalopathy and papilledema at presentation.


METHODS
Twenty-year-old female presented with fever, headache and vomiting. On examination she did not have classical signs of dengue fever and was found to have bilateral papilledema on fundus examination. Detailed work-up did not reveal any other cause of papilledema. Diagnosis of dengue fever was established by blood IgM antibody test on day 7 of illness. Retrospective analysis of CSF (drawn on day 5 of illness) by RT-PCR assay showed a characteristic band of dengue-3 virus. Papilledema was transient and subsided following symptomatic treatment. The patient recovered from acute illness and follow-up was unremarkable.


CONCLUSIONS
Especially in dengue endemic areas, in the patients having acute febrile illness with subtle signs and symptoms suggestive of CNS involvement, dengue virus infection should also be ruled out early in the clinical course.
Tahir
Mohammad
M
Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India. mohdtah@rediffmail.com
Gupta
Ekta
E
Salmani
Sueba
S
Padma
M V
MV
Singh
M B
MB
Dar
L
L
Broor
S
S
Sharma
S K
SK
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D020805:Central Nervous System Viral Diseases / Q000503:physiopathology; D003715:Dengue / Q000503:physiopathology; D003716:Dengue Virus / Q000276:immunology; D005260:Female; D005334:Fever; D006261:Headache; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D010211:Papilledema; D012367:RNA, Viral / Q000134:cerebrospinal fluid / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014839:Vomiting
D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral