title: Acute hemorrhagic encephalitis: An unusual presentation of dengue viral infection.
abstract: Dengue is a common viral infection worldwide with presentation varying from clinically silent infection to dengue fever, dengue hemorrhagic fever, and severe fulminant dengue shock syndrome. Neurological manifestation usually results from multisystem dysfunction secondary to vascular leak. Presentation as hemorrhagic encephalitis is very rare. Here we present the case of a 13-year-old female admitted with generalized tonic clonic seizures. Plain computed tomography (CT) scan of head revealed hypodensities in bilateral deep gray matter nuclei and right posterior parietal lobe without any hemorrhage. Cerebrospinal fluid (CSF) and serology were positive for IgM and IgG antibodies to dengue viral antigen. Contrast-enhanced magnetic resonance imaging (MRI) revealed multifocal T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in bilateral cerebral parenchyma including basal ganglia. No hemorrhage was seen. She was managed with steroids. As her clinical condition deteriorated, after being stable for 2 days, repeat MRI was done which revealed development of hemorrhage within the lesions, and diagnosis of acute hemorrhagic encephalitis of dengue viral etiology was made.
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Jeyaseelan
authors.initials: J
authors.lastname: Nadarajah
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Kumble Seetharama
authors.initials: KS
authors.lastname: Madhusudhan
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Yadav
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Naval Kumar
authors.initials: NK
authors.lastname: Vikram
keywords: Cerebral hemorrhage; Dengue hemorrhagic encephalopathy, encephalitis; dengue; diffusion-weighted images