title: Acute transverse myelitis following Japanese encephalitis viral infection: an uncommon complication of a common disease.
abstract: Japanese encephalitis (JE) is an epidemic encephalitis characterised by altered sensorium, convulsions, headache, brainstem signs with pyramidal and extrapyramidal features. Immune-mediated manifestation as acute transverse myelitis (ATM) has not been previously reported in JE. We describe a 40-year-old man who presented with an acute onset quadriparesis with urinary retention, which was preceded by fever and headache 3 weeks prior. He had elevated IgM titres against JE virus in serum and cerebrospinal fluid. MRI of cervico-thoracic spine demonstrated signal intensity alterations extending from C1 to D10 spinal segments. The patient was treated with intravenous methyl prednisolone for 5 days. He regained normal power at 6 months follow-up and repeat MRI study demonstrated complete resolution of the lesion. We conclude that in a case of JE, one should be vigilant for early diagnosis of possible complication as ATM, in which an early institution of immunomodulator therapy prevents adverse consequences.
authors.affiliation: Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India. drrajeshverma32@yahoo.com
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Heramba Narayan
authors.initials: HN
authors.lastname: Praharaj
authors.forename: Tushar B
authors.initials: TB
authors.lastname: Patil
authors.forename: Prithvi
authors.initials: P
authors.lastname: Giri
mesh_terms: D000328:Adult; D004664:Encephalitis Virus, Japanese; D004672:Encephalitis, Japanese / Q000150:complications* / Q000473:pathology / Q000821:virology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000134:cerebrospinal fluid / Q000378:metabolism*; D008297:Male; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000821:virology; D011239:Prednisolone / Q000627:therapeutic use; D015398:Signal Transduction / Q000502:physiology; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000821:virology
chemical_list: D005938:Glucocorticoids; D007075:Immunoglobulin M; D011239:Prednisolone